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Background: Evaluation of chest pain patients in emergency departments to distinguish between high-risk patients who require admission and low-risk patients who can be managed as outpatients is a challenging task. Objective: The aim of this study was to evaluate the efficacy of Observation Ward Short Stay Evaluation Service for Chest Pain Protocol to identify and safely discharge low-risk patients with low incidence of major adverse cardiac events within 30 days. Methods: This was a single center prospective observational study, conducted from 1 March 2016 to 31 August 2016 at the Emergency and Trauma Department, Hospital Kuala Lumpur, Kuala Lumpur. Observation Ward Short Stay Evaluation Service for Chest Pain Protocol was used to evaluate patients presented with chest pain or angina equivalents. The components involved Thrombolysis in Myocardial Infarction (TIMI) score, serial electrocardiograms, high-sensitivity cardiac troponin T, and exercise treadmill test. Low-risk patients were patients with TIMI < 2, normal serial electrocardiogram, high-sensitivity cardiac troponin T <= 14 ng/L, and negative exercise treadmill test. If anyone of the components was not fulfilled patients were considered as high risk, and they were either admitted or referred to clinic for further intervention. Low-risk patients were allowed for discharged. All patients were followed-up in 30 days for any incidence of major adverse cardiac events. Results: Totally, 174 patients were studied. Observation Ward Short Stay Evaluation Service for Chest Pain Protocol managed to discharge 102 (58.6%) patients, and 84 (82.4%) of them underwent exercise treadmill test. About 46 (54.8%) patients had negative exercise treadmill test, whereas 38 (45.2%) patients had either positive or inconclusive exercise treadmill test, and they were referred to physician clinic for further cardiac assessment. None of the patients with negative exercise treadmill test developed major adverse cardiac events in 30 days. The sensitivity and the negative predictive value (NPV) of Observation Ward Short Stay Evaluation Service for Chest Pain Protocol were both 100%. Conclusion: Observation Ward Short Stay Evaluation Service for Chest Pain Protocol can be applied in emergency departments to identify and safely discharge patients with low risk of major adverse cardiac events in 30 days.

In recent years, numerous prognostic models have been developed to predict VO2max. Nevertheless, their accuracy in endurance athletes (EA) stays mostly unvalidated. This study aimed to compare predicted VO2max (pVO2max) with directly measured VO2max by assessing the transferability of the currently available prediction models based on their R.sup.2, calibration-in-the-large, and calibration slope. 5,260 healthy adult EA underwent a maximal exertion cardiopulmonary exercise test (CPET) (84.76% male; age 34.6±9.5 yrs.; VO2max 52.97±7.39 mL·min.sup.-1 ·kg.sup.-1, BMI 23.59±2.73 kg·m.sup.-2). 13 models have been selected to establish pVO2max. Participants were classified into four endurance subgroups (high-, recreational-, low- trained, and \"transition\") and four age subgroups (18-30, 31-45, 46-60, and [greater than or equal to]61 yrs.). Validation was performed according to TRIPOD guidelines. pVO2max was low-to-moderately associated with direct CPET measurements (p>0.05). Models with the highest accuracy were for males on a cycle ergometer (CE) (Kokkinos R.sup.2 = 0.64), females on CE (Kokkinos R.sup.2 = 0.65), males on a treadmill (TE) (Wasserman R.sup.2 = 0.26), females on TE (Wasserman R.sup.2 = 0.30). However, selected models underestimated pVO2max for younger and higher trained EA and overestimated for older and lower trained EA. All equations demonstrated merely moderate accuracy and should only be used as a supplemental method for physicians to estimate CRF in EA. It is necessary to derive new models on EA populations to include routinely in clinical practice and sports diagnostic.

Objectives The aim of this study was to determine the peak running velocity on the track field (V.sub.peak_TF) based on the laboratory treadmill test (V.sub.peak_T ), and relate the V.sub.peak values as well as their correlation with the 10-km running performance in trained endurance runners. Method Twenty male trained endurance runners (age: 29.5 ± 5.3 years; VÌO.sub.2max : 67.5±17.6 ml · kg.sup.-1 ·min.sup.-1) performed three maximum incremental tests to determine the V.sub.peak : one for V.sub.peak_T determination and two to obtain V.sub.peak_TF on the official track field (400 m), and a 10-km running performance. During the incremental tests, maximum heart rate (HR.sub.max ), maximal rating of perceived exertion (RPE.sub.max ), and peak lactate concentration (LA.sub.peak) were determined. Results The results showed significant difference between the V.sub.peak_TF and V.sub.peak_T (18.1 ± 1.2 vs. 19.2 ± 1.5 km·h.sup.-1, respectively), as well as the total time of the tests, the distance traveled and the RPE.sub.max determined during the tests. A high correlation was observed between the V.sub.peak values (r = 0.94), and between V.sub.peak_TF and V.sub.peak_T with 10-km running performance (r = -0.95 vs. r = -0.89, respectively). Conclusions The good agreement and association with V.sub.peak_T and high correlation with 10-km running performance demonstrate that the novel track field test is efficient for V.sub.peak_TF determination.

Everyday walking often involves walking with divided attention (i.e., dual-tasking). Exercise interventions for older adults should mimic these simultaneous physical and cognitive demands. This proof-of-concept study had a two-fold purpose: 1) identify acute cognitive and gait benefits of a single session of virtual reality treadmill training (VRTT), relative to conventional treadmill training (CTT), and 2) identify differences between those who reduced dual-task costs (i.e., responders) on gait or cognition and those who did not, after the session. Sixty older adults were randomized to complete a single 30-minute session of VRTT (n = 30, 71.2±6.5 years, 22 females) or CTT (n = 30, 72.0±7.7 years, 21 females). Pre- and post-exercise session, participants performed single-task walking, single-task cognitive, and dual-task walking trials while gait and cognition were recorded. Gait variables were gait speed and gait speed variability. Cognition variables were response reaction time, response accuracy, and cognitive throughput. Dual-task effects (DTE) on gait and cognition variables were also calculated. Post-exercise, there were no group differences (all p>0.05). During single- and dual-task trials, both groups walked faster (single-task: F(1, 58) = 9.560, p = 0.003; dual-task: F(1, 58) = 19.228, p<0.001), responded more quickly (single-task: F(1, 58) = 5.054, p = 0.028; dual-task: F(1, 58) = 8.543, p = 0.005), and reduced cognitive throughput (single-task: F(1, 58) = 6.425, p = 0.014; dual-task: F(1, 58) = 28.152, p0.05), but cognitive responders completed fewer years of education (t(58) = 2.114, p = 0.039) and better information processing speed (t(58) = -2.265, p = 0.027) than cognitive non-responders. The results indicate that both VRTT and CTT may acutely improve gait and cognition. Therefore, older adults will likely benefit from participating in either type of exercise. The study also provides evidence that baseline cognition can impact training effects on DTE on cognition.

Wrist-worn accelerometers are emerging as the most common instrument for measuring physical activity in large-scale epidemiological studies, though little is known about the relationship between wrist acceleration and physical activity energy expenditure (PAEE). 1695 UK adults wore two devices simultaneously for six days; a combined sensor and a wrist accelerometer. The combined sensor measured heart rate and trunk acceleration, which was combined with a treadmill test to yield a signal of individually-calibrated PAEE. Multi-level regression models were used to characterise the relationship between the two time-series, and their estimations were evaluated in an independent holdout sample. Finally, the relationship between PAEE and BMI was described separately for each source of PAEE estimate (wrist acceleration models and combined-sensing). Wrist acceleration explained 44-47% between-individual variance in PAEE, with RMSE between 34-39 J•min-1•kg-1. Estimations agreed well with PAEE in cross-validation (mean bias [95% limits of agreement]: 0.07 [-70.6:70.7]) but overestimated in women by 3% and underestimated in men by 4%. Estimation error was inversely related to age (-2.3 J•min-1•kg-1 per 10y) and BMI (-0.3 J•min-1•kg-1 per kg/m2). Associations with BMI were similar for all PAEE estimates (approximately -0.08 kg/m2 per J•min-1•kg-1). A strong relationship exists between wrist acceleration and PAEE in free-living adults, such that irrespective of the objective method of PAEE assessment, a strong inverse association between PAEE and BMI was observed.

Self-pacing treadmills provide advantages for assessing locomotion such as having a controlled environment and ability to accurately collect prolonged data, but the variable sounds from the treadmill belt motors when changing speed could provide artificial sensory feedback to walkers that may influence their gait while on the self-pacing treadmill. We hypothesized that temporal measures of gait on a proportionally-controlled self-pacing treadmill would be significantly different between when sound is present vs removed. Participants (n = 31) walked under two different conditions for five-minute periods each on the self-pacing treadmill: one without headphones, and the other with noise-cancelling headphones playing brown noise to mask the treadmill motor sounds. Mixed effects models were used to assess the impact of condition on temporal gait patterns. A custom accelerometer-based algorithm was created to detect gait events while on the treadmill. Significant differences were found in the average values of swing time, step time, and gait speed between the treadmill conditions. These differences between the two treadmill conditions suggest that self-pacing treadmill walkers may utilize the variable belt motor sounds available to them. Given the potential incorporation of auditory feedback for motor planning when walking on the self-pacing treadmill, researchers should consider belt motor sounds as a potential factor that affects gait patterns.

Although it is relevant to understand spine and lower body motions in healthy individuals for a variety of applications, such as clinical diagnosis, implant design, and the analysis of treatment outcomes, proper assessment and characterization of normative gait symmetry in healthy individuals remains unclear. The purpose of this study was to investigate the in vivo 3-dimensional (3D) spine and lower body gait symmetry kinematics during treadmill walking in healthy individuals. Sixty healthy young adults (30 males and 30 females) were evaluated during normal and fast treadmill walking using a motion capture system approach. Statistical parametric mapping and the normalized symmetry index approaches were used to determine spine, pelvis, and lower body asymmetries during treadmill walking. The spine and pelvis angular motions associated with the left and right lower limb motions, as well as the left and right lower extremity joint angles were compared for normal and fast treadmill walking. The lower lumbar left-right rotation (5.74±0.04°) and hip internal rotation (5.33±0.18°) presented the largest degrees of asymmetry during normal treadmill. Upper lumbar left-right lateral flexion (1.48±0.14°) and knee flexion (2.98±0.13°) indicated the largest asymmetries and during fast treadmill walking. Few asymmetry patterns were similar between normal and fast treadmill walking, whereas others appeared either only during normal or fast treadmill walking in this cohort of participants. These findings could provide insights into better understanding gait asymmetry in healthy individuals, and use them as reference indicators in diagnosing and evaluating abnormal gait function.

Individuals with neurological impairments often exhibit asymmetrical gait patterns. This study explored the potential of using functional electrical stimulation (FES) as a perturbation method during treadmill walking to promote gait symmetry adaptation by investigating whether the FES perturbation could induce gait adaptation concerning spatial and temporal gait symmetry in healthy subjects. In the FES perturbation, both legs received electrical pulses at the same period as the subjects’ initial stride duration, and the temporal gap between the two pulses for each leg was manipulated over a 7-min period. Following this, subjects continued to walk for another 5 minutes without FES. Subjects participated in two trials: implicit and explicit. In the implicit trial, they walked comfortably during FES perturbation without consciously adjusting their gait. In the explicit trial, they voluntarily synchronized their toe-off phase to the stimulation timing. To examine the effects of the FES perturbation, we measured step length and stance time and then analyzed changes in step length and stance time symmetries alongside their subsequent aftereffects. During the explicit trial, subjects adapted their gait patterns to the electrical pulses, resulting in a directional change in stance time (temporal) symmetry, with the left stance becoming shorter than the right. The stance time asymmetry induced by FES perturbation showed a slight residual effect. In the implicit trial, the directional change trend was slightly observed but not statistically significant. No consistent trend in step length (spatial) symmetry changes was observed in either condition, indicating that subjects may adapt their spatial gait patterns independently of their temporal patterns. Our findings suggest that the applied FES perturbation strategy under explicit condition can induce adaptations in subjects’ temporal gait asymmetry, particularly in stance. The implicit condition showed a similar slight trend but was not statistically significant. Further experiments would provide deeper understanding into the mechanism behind subjects’ response to FES perturbations, as well as the long-term effects of these perturbations on the spatial and temporal aspects of gait symmetry.

Although aerobic physical exercise may improve osteoporosis during ageing, the underlying mechanism of the favorable effects remains unclear. The aim of this study was to examine the localized and generalized proinflammatory indicators and the adaptive skeletal responses to treadmill training in aged rats to explore the potential mechanisms by which treadmill training impacts bone deterioration in a natural aged rat model. A total of 24 Sprague Dawley (SD) rats were included in this study. Sixteen of all these animals were twenty-four months natural aged male SD rats, which were distributed into two groups (n = 8/group): AC group with sham treadmill training, and AT group with 8 weeks treadmill training. The remaining 8 were six months male SD rats matched subline and supplier, which were used as the adult control group with sham treadmill training (YC group, n = 8). The serum, bone marrow, fresh femur, tibia, and lumbar spine were harvested for molecular biological analysis, bone mineral density (BMD) testing, and micro-CT analysis after 8 weeks of treadmill training. After 8 weeks of intervention, the results showed that treadmill training increased BMD and inhibited deterioration of bone microarchitecture of hind limb bones. Further analysis showed that treadmill training increased serum P1CP concentration and decreased serum CTX-1level. Interestingly, treadmill training down-regulated the protein expressions of proinflammatory indicators, including NLRP3, proCaspase1, cleaved Caspase1, IL-1[beta], and GSDMD-N, and the mRNA levels of NLRP3, Caspase1, and IL-1[beta] of the bone marrow. In addition, treadmill training also inhibited serum TNF-[alpha] and IL-1[beta] concentration. However, 8 weeks of treadmill training did not increase BMD and bone microarchitecture in the lumbar spine. Treadmill training mitigates the ageing-induced bone loss and reverses the deterioration of bone microarchitecture in hind limbs probably through inhibiting NLRP3/Caspase1/IL-1[beta] signaling to attenuate low-grade inflammation and improve the inflammatory bone microenvironment.

Cancer-related lymphedema (LE) is often caused by radiotherapy and surgery such as lymph node dissection (LND). Previous studies have reported that exercise is beneficial to relieve LE, but the changes in the lymphatic system following exercise are still unclear. This study aimed to examine the changes in lymphatic drainage pathways over the exercise period and beneficial effects of exercise in rats with LE. Twelve rats were randomly allocated into exercise and control groups (EG and CG; n = 6 each). To obtain LE, inguinal and popliteal LND followed by 20 Gy irradiation was performed. Treadmill exercise was 30 minutes/day, 5 days/week over the four-week period. Consecutive indocyanine green (ICG) lymphography images were collected and classified into five patterns: i) linear; ii) splash; iii) stardust; iv) diffuse, and v) none. Ankle thickness was measured weekly. Histopathological evaluation was performed to examine the skin thickness, collagen area fraction (%) and lymphatic vessel density in harvested tissue. ICG lymphography exhibited more linear and splash patterns in the EG at week 3. The difference of swelling between both groups was significantly different at week 4 (p = 0.016). Histopathologic data revealed a thinner epidermis (p = 0.041) and dermis (p = 0.002), lower collagen area fraction (%, p = 0.002), and higher lymph vessel density (p = 0.002) in the EG than the CG. In conclusion, we found that postoperative exercise can facilitate improvement in lymphatic fluid retention in the lymphedema rat model, resulting in improvement of pathological conditions in the lymphatic system.