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Exercise limitation in COVID-19 survivors is poorly explained. In this retrospective study, cardiopulmonary exercise testing (CPET) was coupled with an oxidative stress assessment in COVID-19 critically ill survivors (ICU group). Thirty-one patients were included in this group. At rest, their oxygen uptake (VO2) was elevated (8 [5.6–9.7] mL/min/kg). The maximum effort was reached at low values of workload and VO2 (66 [40.9–79.2]% and 74.5 [62.6–102.8]% of the respective predicted values). The ventilatory equivalent for carbon dioxide remained within normal ranges. Their metabolic efficiency was low: 15.2 [12.9–17.8]%. The 50% decrease in VO2 after maximum effort was delayed, at 130 [120–170] s, with a still-high respiratory exchange ratio (1.13 [1–1.2]). The blood myeloperoxidase was elevated (92 [75.5–106.5] ng/mL), and the OSS was altered. The CPET profile of the ICU group was compared with long COVID patients after mid-disease (MLC group) and obese patients (OB group). The MLC patients (n = 23) reached peak workload and predicted VO2 values, but their resting VO2, metabolic efficiency, and recovery profiles were similar to the ICU group to a lesser extent. In the OB group (n = 15), no hypermetabolism at rest was observed. In conclusion, the exercise limitation after a critical COVID-19 bout resulted from an altered metabolic profile in the context of persistent inflammation and oxidative stress. Altered exercise and metabolic profiles were also observed in the MLC group. The contribution of obesity on the physiopathology of exercise limitation after a critical bout of COVID-19 did not seem relevant.

The serve is an important stroke in any high level tennis game. A well-mastered serve is a substantial advantage for players. However, because of its repeatability and its intensity, this stroke is potentially deleterious for upper limbs, lower limbs and trunk. The trunk is a vital link in the production and transfer of energy from the lower limbs to the upper limbs; therefore, kinematic disorder could be a potential source of risk for trunk injury in tennis. This research studies the case of a professional tennis player who has suffered from a medical tear on the left rectus abdominis muscle after tennis serve. The goal of the study is to understand whether the injury could be explained by an inappropriate technique. For this purpose, we analyzed in three dimensions the kinematic and kinetic aspects of the serve. We also performed isokinetic tests of the player's knees. We then compared the player to five other professional players as reference. We observed a possible deficit of energy transfer because of an important anterior pelvis tilt. Some compensation made by the player during the serve could be a possible higher abdominal contraction and a larger shoulder external rotation. These particularities could induce an abdominal overwork that could explain the first injury and may provoke further injuries. Key pointsIn the proximal-distal sequence, energy is transmitted from lower limbs to upper limps via trunk.The 3D analysis tool is an indispensable test for an objective evaluation of the kinematic in the tennis serve.Multiple evaluations techniques are useful for fuller comprehension of the kinematics and contribute to the awareness of the player's staff concerning pathologies and performance.

Statistical postprocessing techniques are nowadays key components of the forecasting suites in many national meteorological services (NMS), with, for most of them, the objective of correcting the impact of different types of errors on the forecasts. The final aim is to provide optimal, automated, seamless forecasts for end users. Many techniques are now flourishing in the statistical, meteorological, climatological, hydrological, and engineering communities. The methods range in complexity from simple bias corrections to very sophisticated distribution-adjusting techniques that incorporate correlations among the prognostic variables. The paper is an attempt to summarize the main activities going on in this area from theoretical developments to operational applications, with a focus on the current challenges and potential avenues in the field. Among these challenges is the shift in NMS toward running ensemble numerical weather prediction (NWP) systems at the kilometer scale that produce very large datasets and require high-density high-quality observations, the necessity to preserve space-time correlation of high-dimensional corrected fields, the need to reduce the impact of model changes affecting the parameters of the corrections, the necessity for techniques to merge different types of forecasts and ensembles with different behaviors, and finally the ability to transfer research on statistical postprocessing to operations. Potential new avenues are also discussed.

Plants respond to herbivory by mounting a defense. Some plant‐eating spider mites (Tetranychus spp.) have adapted to plant defenses to maintain a high reproductive performance. From natural populations we selected three spider mite strains from two species, Tetranychus urticae and Tetranychus evansi, that can suppress plant defenses, using a fourth defense‐inducing strain as a benchmark, to assess to which extent these strains suppress defenses differently. We characterized timing and magnitude of phytohormone accumulation and defense‐gene expression, and determined if mites that cannot suppress defenses benefit from sharing a leaf with suppressors. The nonsuppressor strain induced a mixture of jasmonate‐ (JA) and salicylate (SA)‐dependent defenses. Induced defense genes separated into three groups: ‘early’ (expression peak at 1 d postinfestation (dpi)); ‘intermediate’ (4 dpi); and ‘late’, whose expression increased until the leaf died. The T. evansi strains suppressed genes from all three groups, but the T. urticae strain only suppressed the late ones. Suppression occurred downstream of JA and SA accumulation, independently of the JA–SA antagonism, and was powerful enough to boost the reproductive performance of nonsuppressors up to 45%. Our results show that suppressing defenses not only brings benefits but, within herbivore communities, can also generate a considerable ecological cost when promoting the population growth of a competitor.

Background Plants have inducible defenses to combat attacking organisms. Hence, some herbivores have adapted to suppress these defenses. Suppression of plant defenses has been shown to benefit herbivores by boosting their growth and reproductive performance. Results We observed in field-grown tomatoes that spider mites ( Tetranychus urticae ) establish larger colonies on plants already infested with the tomato russet mite ( Aculops lycopersici ). Using laboratory assays, we observed that spider mites have a much higher reproductive performance on russet mite-infested plants, similar to their performance on the jasmonic acid (JA)-biosynthesis mutant def-1 . Hence, we tested if russet mites suppress JA-responses thereby facilitating spider mites. We found that russet mites manipulate defenses: they induce those mediated by salicylic acid (SA) but suppress those mediated by JA which would otherwise hinder growth. This suppression of JA-defenses occurs downstream of JA-accumulation and is independent from its natural antagonist SA. In contrast, spider mites induced both JA- and SA-responses while plants infested with the two mite species together display strongly reduced JA-responses, yet a doubled SA-response. The spider mite-induced JA-response in the presence of russet mites was restored on transgenic tomatoes unable to accumulate SA ( nahG ), but russet mites alone still did not induce JA-responses on nahG plants. Thus, indirect facilitation of spider mites by russet mites depends on the antagonistic action of SA on JA while suppression of JA-defenses by russet mites does not. Furthermore, russet mite-induced SA-responses inhibited secondary infection by Pseudomonas syringae ( Pst ) while not affecting the mite itself. Finally, while facilitating spider mites, russet mites experience reduced population growth. Conclusions Our results show that the benefits of suppressing plant defenses may diminish within communities with natural competitors. We show that suppression of defenses via the JA-SA antagonism can be a consequence, rather than the cause, of a primary suppression event and that its overall effect is determined by the presence of competing herbivores and the distinct palette of defenses these induce. Thus, whether or not host-defense manipulation improves an herbivore’s fitness depends on interactions with other herbivores via induced-host defenses, implicating bidirectional causation of community structure of herbivores sharing a plant.

Upper abdominal surgery results in a postoperative restrictive pulmonary syndrome. Bi-level positive airway pressure (BiPAP System; Respironics Inc; Murrysville, Pa), which combines pressure support ventilation and positive end-expiratory pressure via a nasal mask, could allow alveolar recruitment during inspiration and prevent expiratory alveolar collapse, and therefore limit the postoperative pulmonary restrictive syndrome. This study investigated the effect of BiPAP on postoperative pulmonary function in obese patients after gastroplasty. Prospective controlled randomized study. GI surgical ward in a university hospital. Thirty-three morbidly obese patients scheduled for gastroplasty were studied. The patients were assigned to one of three techniques of ventilatory support during the first 24 h postoperatively: O2 via a face mask, BiPAP System 8/4, with inspiratory and expiratory positive airway pressure set at 8 and 4 cm H2O, respectively, or BiPAP System 12/4 set at 12 and 4 cm H2O. Pulmonary function (FVC, FEV1, and peak expiratory flow rate [PEFR]) were measured the day before surgery, 24 h after surgery, and on days 2 and 3. Oxygen saturation by pulse oximeter (SpO2) was also recorded during room air breathing. Three patients were excluded. After surgery, FVC, FEV1, PEFR, and SpO2 significantly decreased in the three groups. On day 1, FVC and FEV1 were significantly improved in the group BiPAP System 12/4, as compared with no BiPAP; SpO2 was also significantly improved. After removal of BiPAP System 12/4, these benefits were maintained, allowing faster recovery of pulmonary function. No significant effects were observed on PEFR. BiPAP System 8/4 had no significant effect on the postoperative pulmonary restrictive syndrome. Prophylactic use of BiPAP System 12/4 during the first 24 h postoperatively significantly reduces pulmonary dysfunction after gastroplasty in obese patients and accelerates reestablishment of preoperative pulmonary function.

Background Morbid obesity results in marked respiratory pathophysiologic changes that may lead to impaired intraoperative gas exchange. The decelerating inspiratory flow and constant inspiratory airway pressure resulting from pressure-controlled ventilation (PCV) may be more adapted to these changes and improve gas exchanges compared with volume-controlled ventilation (VCV). Methods Forty morbidly obese patients scheduled for gastric bypass were included in this study. Total intravenous anesthesia was given using the target-controlled infusion technique. During the first intraoperative hour, VCV was used and the tidal volume was adjusted to keep end-tidal PCO 2 around 35 mmHg. After 1 h, patients were randomly allocated to 30-min VCV followed by 30-min PCV or the opposite sequence using a Siemens® Servo 300. FiO 2 was 0.6. During PCV, airway pressure was adjusted to provide the same tidal volume as during VCV. Arterial blood was sampled for gas analysis every 15 min. Ventilatory parameters were also recorded. Results Peak inspiratory airway pressures were significantly lower during PCV than during VCV ( P   <  0.0001). The other ventilatory parameters were similar during the two periods of ventilation. PaO 2 and PaCO 2 were not significantly different during PCV and VCV. Conclusion PCV does not improve gas exchange in morbidly obese patients undergoing gastric bypass compared to VCV.

Background and ObjectivesSedation is often requested during local and regional anesthesia. However, some surgical procedures, such as plastic surgery, require conscious sedation, which may be difficult to achieve. Hypnosis, used routinely to provide conscious sedation in the authors’ Department of Plastic Surgery, results in high patient and surgeon satisfaction. The authors conducted a retrospective study to investigate the benefits of hypnosis in supplementing local anesthesia.MethodsThe study included 337 patients undergoing minor and major plastic surgical procedures under local anesthesia and conscious intravenous sedation. Patients were divided into three groups depending on the sedation technique: intravenous sedation (n = 137) using only midazolam and alfentanil; hypnosis (n = 172), during which patients achieved a hypnotic trance level with age regression; and relaxation (n = 28), comprising patients in whom hypnosis was induced without attaining a trance level. In all three groups, midazolam and alfentanil were titrated to achieve patient immobility, in response to patient complaints, and to maintain hemodynamic stability. Midazolam and alfentanil requirements; intra- and postoperative pain scores; as well as pre-, intra-, and postoperative anxiety scores, reported on a 10-cm visual analog scale, were recorded and compared in the three groups.ResultsIntraoperative anxiety reported by patients in the hypnosis group (0.7 ± 0.11) and in the relaxation group (2.08 ± 0.4) was significantly (P < .001) less than in the intravenous sedation group (5.6 ± 1.6). Pain scores during surgery were significantly greater in the intravenous sedation group (4.9 ± 0.6) than in the hypnosis group (1.36 ± 0.12; P < .001) and the relaxation group (1.82 ± 0.6; P < .01). Furthermore, midazolam requirements were significantly lower in the hypnosis group (P < .001) and in the relaxation group (P < .01) as compared with the intravenous sedation group: respectively, 0.04 ± 0.002, 0.07 ± 0.005, and 0.11 ± 0.01 mg/kg/h. Alfentanil requirements were significantly decreased in the hypnosis group, as compared with the intravenous sedation group: 10.2 ± 0.6 μg/kg/h versus 15.5 ± 2.07 μg/kg/h; P < .002. In the relaxation group, alfentanil requirements were 14.3 ± 1.5 μg/kg/h (ns). Postoperative nausea and vomiting were reported by 1.2% of patients in the hypnosis group, 12.8% in the relaxation group and 26.7% in the intravenous sedation group. Greater patient satisfaction with the anesthetic procedure and greater surgical comfort were also reported in the hypnosis group.ConclusionsSuccessful hypnosis as an adjunct sedation procedure to conscious intravenous sedation provided better pain and anxiety relief than conventional intravenous sedation and allowed for a significant reduction in midazolam and alfentanil requirements. Patient satisfaction was significantly improved.

Statistical postprocessing techniques are nowadays key components of the forecasting suites in many National Meteorological Services (NMS), with for most of them, the objective of correcting the impact of different types of errors on the forecasts. The final aim is to provide optimal, automated, seamless forecasts for end users. Many techniques are now flourishing in the statistical, meteorological, climatological, hydrological, and engineering communities. The methods range in complexity from simple bias corrections to very sophisticated distribution-adjusting techniques that incorporate correlations among the prognostic variables. The paper is an attempt to summarize the main activities going on this area from theoretical developments to operational applications, with a focus on the current challenges and potential avenues in the field. Among these challenges is the shift in NMS towards running ensemble Numerical Weather Prediction (NWP) systems at the kilometer scale that produce very large datasets and require high-density high-quality observations; the necessity to preserve space time correlation of high-dimensional corrected fields; the need to reduce the impact of model changes affecting the parameters of the corrections; the necessity for techniques to merge different types of forecasts and ensembles with different behaviors; and finally the ability to transfer research on statistical postprocessing to operations. Potential new avenues will also be discussed.