Background and objectives To investigate the feasibility of delivering a functional exercise-based prehabilitation intervention and its effects on postoperative length of hospital stay, preoperative physical functioning and health-related quality of life in elective colorectal surgery. Materials and methods In this randomised controlled feasibility trial, 22 elective colorectal surgery patients were randomly assigned to exercise prehabilitation (n = 11) or standard care (n = 11). Feasibility of delivering the intervention was assessed based on recruitment and compliance to the intervention. Impact on postoperative length of hospital stay and complications, preoperative physical functioning (timed up and go test, five times sit to stand, stair climb test, handgrip dynamometry and 6-min walk test) and health-related quality of life were also assessed. Results Over 42% of patients (84/198) screened were deemed ineligible for prehabilitation due to insufficient time existing prior to scheduled surgery. Of those who were eligible, approximately 18% consented to the trial. Median length of hospital stay was 8 [range 6-27] and 10 [range 5-12] days respectively for the standard care and prehabilitation groups. Patterns towards preoperative improvements for the timed up and go test, stair climb test and 6-min walk test were observed for all participants receiving prehabilitation but not standard care. Conclusions Despite prehabilitation appearing to convey positive benefits on physical functioning, short surgical wait times and patient engagement represent major obstacles to implementing exercise prehabilitation programmes in colorectal cancer patients.
Aims The aim of this study was to compare the effects of aspirin on platelet function as measured by the 'classical' template bleeding time with a new ex vivo method measuring closure times using the PFA-100@ machine. Platelet aggregation in response to arachidonic acid was also measured ex vivo. Methods The trial was a randomized, double-blind, placebo-controlled crossover design, with each volunteer taking 750 mg aspirin (BP) or placebo, three times a day for 5 days, with an 18 day wash-out period between treatments. Bleeding times and closure times were measured before the first dose on the first day and 0.5 h after the last dose on the fifth day of each treatment period. They were also measured 2 weeks after the last day of the trial. Results Baseline bleeding times ( pre-placebo) were 415 s using the Simplate, whilst baseline closure times were 115 s using the PFA-100@. Aspirin treatment caused an increase of both the template bleeding time (61%) and the closure time of the PFA-100@ (79%) when compared with the effects of placebo. The platelet aggregatory response to arachidonic acid was completely inhibited following aspirin treatment and was unaffected following placebo. Two weeks after the end of the trial, all values had returned to pre-treatment levels. The template bleeding time was unaltered in 1 of the 12 volunteers during aspirin treatment and was significantly prolonged in 3 of the 12 volunteers during placebo treatment. The PFA-100@ closure time was unaltered in 1 of the 12 volunteers during aspirin treatment and was prolonged in 1 subject during placebo treatment. Conclusions The change in closure time using the PFA-100@ is as sensitive and reproducible to the effects of aspirin on platelet function as is the template bleeding time test. However, the PFA-100@ produced less variable effects with fewer false positive results.
Inhalation of an aqueous aerosol of citric acid caused bronchoconstriction in anaesthetized guinea‐pigs which was abolished by bilateral vagal section. Conscious guinea‐pigs developed slow, laboured breathing within 90 s of exposure to citric acid aerosol. The onset of this pattern of breathing was delayed by prior aerosol administration of atropine, ipratropium bromide, isoprenaline and tetracaine. The data suggest that exposure of guinea‐pigs to citric acid may be a useful model of reflex bronchoconstriction.
This study examined the dose-response effects of ingesting different sodium concentrations on markers of hydration and tennis skill. Twelve British nationally-ranked tennis players (age: 21.5 ± 3.1 years; VO 2peak : 45.5 ± 4.4 ml. kg. min −1) completed four identical indoor tennis training sessions in a cluster randomized, single-blind, placebo-controlled, crossover design. Twenty-minutes prior to each training session, participants consumed a 250 ml sodium-containing beverage (10, 20, 50 mmol/L) or a placebo (0 mmol/L), and continued to consume 1,000 ml of the same beverage at set periods during the 1-h training session. Tennis groundstroke and serve performance, agility, urine osmolality, fluid loss, sodium sweat loss and perceptual responses (rating of perceived exertion (RPE), thirst, and gastrointestinal (GI) discomfort) were assessed. Results showed that ingesting 50 mmol/L sodium reduced urine osmolality (−119 mOsmol/kg; p = 0.037) and improved groundstroke performance (5.4; p < 0.001) compared with placebo. This was associated with a reduction in RPE (−0.42; p = 0.029), perception of thirst (−0.58; p = 0.012), and GI discomfort (−0.55; p = 0.019) during the 50 mmol/L trial compared with placebo. Linear trend analysis showed that ingesting greater concentrations of sodium proportionately reduced urine osmolality (β = −147 mOsmol/kg; p = 0.007) and improved groundstroke performance (β = 5.6; p < 0.001) in a dose response manner. Perceived thirst also decreased linearly as sodium concentration increased (β = −0.51; p = 0.044). There was no evidence for an effect of sodium consumption on fluid loss, sweat sodium loss, serve or agility performance (p > 0.05). In conclusion, consuming 50 mmol/L of sodium before and during a 1-h tennis training session reduced urine osmolality and improved groundstroke performance in nationally-ranked tennis players. There was also evidence of dose response effects, showing that ingesting greater sodium concentrations resulted in greater improvements in groundstroke performance. Munson et al. Sodium Ingestion Improves Tennis Skill The enhancement in tennis skill may have resulted from an attenuation of symptomologic distracters associated with hypohydration, such as RPE, thirst and GI discomfort.
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