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Background and Purpose: Resistance training exercise provides increases in muscle size and is used by coaches and health care professional as a tool to improve functional performance. The aim of the present study was to investigate the effect of 10 weeks of resistance training program performed on the bench press (BP) exercise on the hypertrophic responses of four different muscles (pectoralis major, anterior and medial deltoid, brachii, and pectoralis minor) involved in the task compared to controls., Methods: Twenty-four healthy males were recruited, and thirteen performed a resistance training intervention while eleven were control. RT group trained for 10 weeks and the protocol consisted of a time under tension for each set of 36s (3-4 sets) with 12 repetitions with an intensity of 50-55% of the 1RM, a training frequency of 3 times a week, with a 3 min rest between sets. Muscle cross-sectional area (CSA) was measure by magnetic resonance imaging., Results: Individuals in the RT group demonstrated higher changes in CSA of the pectoralis major, pectoralis minor, anterior deltoid, and triceps brachii (P ≤ 0.019) than in the Control group. It was identified in the RT group higher increases in CSA of all muscles compared to medial deltoid (P ≤ 0.016), while pectoralis major demonstrated larger increases in CSA than pectoralis minor and triceps brachii (P ≤ 0.030)., Conclusions: We demonstrated that 10 weeks of resistance training performed on the BP exercise led to increases in muscle size of the muscles involved in the task, but not in the same magnitude., Competing Interests: Declaration of competing interest The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Addressing climate change constitutes one of the major scientific challenges of this century, and it is widely acknowledged that anthropogenic CO 2 emissions largely contribute to this issue. To achieve the "net-zero" target and keep the rise in global average temperature below 1.5 °C, negative emission technologies must be developed and deployed at a large scale. This study investigates the feasibility of using membranes as direct air capture (DAC) technology to extract CO 2 from atmospheric air to produce low-purity CO 2 . In this work, a two-stage hollow fiber membrane module process is designed and modeled using the AVEVA Process Simulation platform to produce a low-purity (≈5%) CO 2 permeate stream. Such low-purity CO 2 streams could have several possible applications such as algae growth, catalytic oxidation, and enhanced oil recovery. An operability analysis is performed by mapping a feasible range of input parameters, which include membrane surface area and membrane performance metrics, to an output set, which consists of CO 2 purity, recovery, and net energy consumption. The base case for this simulation study is generated considering a facilitated transport membrane with high CO 2 /N 2 separation performance (CO 2 permeance = 2100 GPU and CO 2 /N 2 selectivity = 1100), when tested under DAC conditions. With a constant membrane area, both membranes' intrinsic performances are found to have a considerable impact on the purity, recovery, and energy consumption. The area of the first module plays a dominant role in determining the recovery, purity, and energy demands, and in fact, increasing the area of the second membrane has a negative impact on the overall energy consumption, without improving the overall purities. The CO 2 capture capacity of DAC units is important for implementation and scale-up. In this context, the performed analysis showed that the m-DAC process could be appropriate as a small-capacity system (0.1-1 Mt/year of air), with reasonable recoveries and overall purity. Finally, a preliminary CO 2 emissions analysis is carried out for the membrane-based DAC process, which leads to the conclusion that the overall energy grid must be powered by renewable sources for the technology to qualify within the negative emissions category., Competing Interests: The authors declare no competing financial interest., (© 2024 The Authors. Published by American Chemical Society.)

Background: Little is known about treatment variability across US hospitals for patients with chronic limb-threatening ischemia (CLTI)., Methods and Results: Data were collected from the 2016 to 2018 National Inpatient Sample. All patients aged ≥18 years, admitted to nonfederal US hospitals with a primary diagnosis of CLTI, were identified. Patients were classified according to their clinical presentation (rest pain, skin ulceration, or gangrene) and were further characterized according to the treatment strategy used. The primary outcome of interest was variability in CLTI treatment, as characterized by the median odds ratio. The median odds ratio is defined as the likelihood that 2 similar patients would be treated with a given modality at 1 versus another randomly selected hospital. There were 15 896 (weighted n=79 480) hospitalizations identified where CLTI was the primary diagnosis. Medical therapy alone, endovascular revascularization ± amputation, surgical revascularization ± amputation, and amputation alone were used in 4057 (25%), 5390 (34%), 3733 (24%), and 2716 (17%) patients, respectively. After adjusting for both patient- and hospital-related factors, the median odds ratio (95% CI) for medical therapy alone, endovascular revascularization ± amputation, surgical revascularization ± amputation, any revascularization, and amputation alone were 1.28 (1.19-1.38), 1.86 (1.77-1.95), 1.65 (1.55-1.74), 1.37 (1.28-1.45), and 1.42 (1.27-1.55), respectively., Conclusions: Significant variability in CLTI treatment exists across US hospitals and is not fully explained by patient or hospital characteristics.

Introduction: Effects on strength performance and muscle activation in the contralateral limb have been observed after training with the ipsilateral limb (IL). Cross fatigue effects in the contralateral limb (CL) can occur at intervals of up to 48 h after a training session performed with the ipsilateral limb. The objective of this study was to verify the effect of a training session in the ipsilateral limb, on the strength and activation of the muscles in the contralateral limb also submitted to the training protocol., Methods: 10 untrained men (mean ± SD: age = 23.7 ± 4.9 years) performed unilateral knee extension with both limbs in equated protocols, in two conditions with different intervals between limbs - 20 min and 24 h., Results: There were no differences in the comparison of the force produced between the pre x post interventions with the CL limb, as well as in the activation of the quadriceps during its performance. These results were similar for the two different intervals between the protocols., Conclusion: It was concluded that when the CL member performs the protocol after the IL, the responses in the CL depend mainly on the requirement imposed on the protocol performed by this member, without influence of the training protocol performed previously with the IL member., Competing Interests: Declaration of competing interest None, (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Magnetic resonance imaging (MRI) is a well-used technique to assess muscle size and can be acquired on different planes. Pectoralis major (PM) and triceps brachii (TB) muscles are often acquired and analyzed on the axial plane, however it is unknown if anatomical cross-sectional area (CSA) calculated from different planes will affect the muscle size-strength relationship. Thus, the first aim of the present study was to identify if the CSA of the PM and TB measured on different planes presents a similar muscle size-strength relationship. A secondary aim was to investigate if the quantification of CSA of the PM and TB muscles are similar between sagittal and axial plane., Methods: Fifteen males underwent an MRI examination, and after that, one-repetition maximum (1RM) test was performed., Results: There was a significant relationship between 1RM and PM CSA measured on the axial and sagittal plane (r≤0.81), while the relationship with TB CSA was only good on the axial plane (r=0.65) and not significant on the sagittal plane (r=0.27). ICC between planes was excellent for PM CSA (0.96) with Bland-Altman procedure showing agreement between planes (d=0.376; P=0.612). Contrarily, TB CSA ICC was week (0.07), with Bland-Altman procedure showing no agreement between planes (d=-24.49; P=0.022)., Conclusions: CSA measured at axial plane from PM and TB muscles showed a significant relationship with 1RM, while only PM CSA on the sagittal plane showed a significant relationship with 1RM. Finally, it was demonstrated that PM images showed a great reliability between planes, which was not true for TB muscle.

Steam methane reforming (SMR) currently supplies 76% of the world's hydrogen (H 2 ) demand, totaling ∼70 million tonnes per year. Developments in H 2 production technologies are required to meet the rising demand for cleaner, less costly H 2 . Therefore, palladium membrane reactors (Pd-MR) have received significant attention for their ability to increase the efficiency of traditional SMR. This study performs novel economic analyses and constrained, nonlinear optimizations on an intensified SMR process with a Pd-MR. The optimization extends beyond the membrane's operation to present process set points for both the conventional and intensified H 2 processes. Despite increased compressor and membrane capital costs along with electric utility costs, the SMR-MR design offers reductions in the natural gas usage and annual costs. Economic comparisons between each plant show Pd membrane costs greater than $25 000/m 2 are required to break even with the conventional design for membrane lifetimes of 1-3 years. Based on the optimized SMR-MR process, this study concludes with sensitivity analyses on the design, operational, and cost parameters for the intensified SMR-MR process. Overall, with further developments of Pd membranes for increased stability and lifetime, the proposed SMR-MR design is thus profitable and suitable for intensification of H 2 production., Competing Interests: The authors declare no competing financial interest., (© 2023 The Authors. Published by American Chemical Society.)

Introduction: Women with bladder endometriosis often present with more advanced stages of endometriosis. Robotic surgery has emerged as a promising approach to the management of bladder endometriosis. This systematic review aims to analyze the current literature on robotic surgery for bladder endometriosis and describe our systematic approach to surgical treatment., Methods: This review followed the PRISMA guidelines, which ensured a comprehensive and transparent approach to selecting and evaluating relevant studies. We conducted a thorough literature search to identify studies that investigated the use of robotic surgery for bladder endometriosis. Relevant databases were searched, and inclusion and exclusion criteria were applied to select eligible studies. Data extraction and analysis were performed to assess the outcomes and effectiveness of robotic surgery for the treatment of bladder endometriosis., Results: We did not find any randomized clinical trials with the use of robotics in the treatment of bladder endometriosis. We found only two retrospective studies comparing robotic surgery with laparoscopy, and another retrospective study comparing robotic surgery, laparoscopy, and laparotomy in the treatment of bladder endometriosis. All the other 12 studies were solely case reports. Despite the lack of robust evidence in the literature, the studies demonstrated that robotic surgery is feasible and is associated with reduced postoperative pain, shorter hospital stays, and faster recovery., Conclusions: The utilization of robotic technology is a promising option for the surgical management of bladder endometriosis. We advocate a surgical systematic approach for the robotic treatment of bladder endometriosis. Robotic technology, with its 3D vision, instrumental degrees of freedom, and precision, particularly in suturing, may provide potential benefits over traditional laparoscopy.

Bleeding events result in morbidity and mortality in patients who underwent percutaneous coronary intervention (PCI). There are limited data on the predicting bleeding complications in patients who underwent stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) and Academic Research Consortium for High Bleeding Risk (ARC-HBR) scores' ability to predict in-hospital outcomes in patients who underwent PCI. Consecutive patients who underwent PCI at tertiary centers from January 2016 to March 2018 were identified and the bleeding risk scores were calculated. The primary end point was the National Cardiovascular Data Registry-defined in-hospital bleeding stratified by low versus high predicted bleeding risk. The major and net adverse cardiovascular events were also examined. The discriminatory ability of the risk models was determined using receiver operating characteristic curves. Among 3,659 patients studied, the in-hospital major bleeding was 3.3% (n = 121). The patients characterized as high bleeding risk by either criterion had significantly higher bleeding rates than those meeting the low-risk criteria (ARC-HBR 5.4% vs 3.3%, p <0.001; PRECISE-DAPT 5.8% vs 2.4%, p <0.001), and higher major adverse cardiovascular events and net adverse clinical events. These risk estimates showed moderate and similar predictive ability (ARC-HBR high-risk area under the receiver operating characteristic curve [AUC] 0.62, PRECISE-DAPT ≥25 AUC 0.61, p = 0.49), with no incremental benefit to adding the estimates (AUC 0.60). The subgroup analysis revealed that women had higher bleeding rates than men (5.53% vs 2.39%, p <0.001); however, the predictive ability of the criteria were similar in women and men. The patients identified as having a high bleeding risk by the PRECISE-DAPT and the ARC-HBR criteria before PCI are at high risk for in-hospital bleeding and adverse outcomes independent of gender. The 2 scores have moderate predictive ability for bleeds. Further study is needed to determine strategies to reduce risk in this population., Competing Interests: Disclosures Dr. Aronow is a consultant for Philips, Silk Road Medical; Dr. Abbott receives research grants form Boston Scientific and MicroPort and is a consultant for Abbott, Medtronic, Philips, and Recor. The remaining authors have no conflicts of interest to declare., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: The effects of ROM manipulation on muscle strength and hypertrophy response remain understudied in long-term interventions. Thus, we compared the changes in strength and regional muscle hypertrophy after training in protocols with different ranges of motion (ROM) in the seated dumbbell preacher curl exercise using a within-participant experimental design., Design and Methods: Nineteen young women had one arm randomly assigned to train in the initial ROM (INITIAL ROM : 0°-68°; 0° = extended elbow) while the contralateral arm trained in the final ROM (FINAL ROM : 68°-135°), three times per week over an eight-week study period. Pre- and post-training assessments included one repetition maximum (1RM) testing in the full ROM (0°-135°), and measurement of biceps brachii cross-sectional area (CSA) at 50% and 70% of humerus length. Paired t -tests were used to compare regional CSA changes between groups, the sum of CSA changes at 50% and 70% (CSA summed ), and the strength response between the training protocols., Results: The INITIAL ROM protocol displayed a greater CSA increase than FINAL ROM protocol at 70% of biceps length ( p = 0.001). Alternatively, we observed similar increases between the protocols for CSA at 50% ( p = 0.311) and for CSA summed ( p = 0.111). Moreover, the INITIAL ROM protocol displayed a greater 1RM increase than FINAL ROM ( p < 0.001)., Conclusions: We conclude that training in the initial angles of elbow flexion exercise promotes greater distal hypertrophy of the biceps brachii muscle in untrained young women. Moreover, the INITIAL ROM condition promotes a greater dynamic strength increase when tested at a full ROM compared to the FINAL ROM .

The first aim was to investigate the impact of different electromyography (EMG) parameters as a reference to normalize the EMG amplitude of the superficial quadriceps femoris muscles across different sets of a knee extension exercise. The second aim is to examine the reliability between days of the EMG parameters used as a reference. Eleven young males attended the laboratory on 4 different days and performed one repetition maximum test, maximumvoluntary isometric contractions, and a resistance training protocol until failure. Surface EMG was placed over the rectus femoris, vastus lateralis, and vastus medialis muscles. Seven EMG parameters were calculated from the tasks and used to normalize EMG amplitude measured during the resistance training protocol. A repeated-measures two-way ANOVA was used (normalized EMG amplitude × set) to compare normalized EMG across sets, while an intraclass correlation coefficient, coefficient of variation, and Bland-Altman plots were used to calculate the intra-day reliability of the EMG parameters. The present investigation showed that normalized EMG amplitude of the superficial muscles of the quadriceps measured during a knee extension exercise is influenced by the EMG parameter and depends on the muscle. While rectus femoris and vastus lateralis normalized EMG amplitude presented one parameter among seven showing similar value to the other parameters, VM showed two. Lastly, all EMG parameters for all muscles presented an overall excellent reliability and agreement between days., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Process modularization is an alternative process design and construction framework, in which modular units are independent and replaceable blocks of a process system. While modular plants have higher efficiency and are safer to construct than conventional stick-built plants (Roy, S. Chem. Eng. Prog . 2017 , 113 , 28-31), they are significantly more challenging to operate because of the loss in the control degrees of freedom that comes with process integration and intensification (Bishop, B. A.; Lima, F. V. Processes 2021 , 9 , 2165). To address this challenge, in this work, operability analyses are performed to consider the design and operation of modular units. Initially, a steady-state operability analysis is employed to find a set of feasible modular designs that are able to operate considering different modular plant conditions. A dynamic operability analysis is then applied to the feasible designs to identify the operable designs that are capable of rejecting the operational disturbances. Lastly, a closed-loop control measure is introduced to compare the performances of the different operable designs. The proposed approach is implemented in a modular membrane reactor to find a set of operable designs considering different natural gas wells, and the respective closed-loop nonlinear model predictive control performance of these units is evaluated., Competing Interests: The authors declare no competing financial interest., (© 2023 American Chemical Society.)

Background: Although variation in the management of patients with non-ST-elevation myocardial infarction (NSTEMI) is well documented across US hospitals, few data exist characterizing variation in outcomes following specific management strategies., Methods: Admissions for NSTEMI to hospitals performing coronary angiography, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) surgery between 2016 and 2018 were identified from the National Inpatient Sample. Patients were categorized according to treatment rendered (medical therapy alone, angiography without revascularization, PCI, or CABG). The primary end point was variation in the incidence of composite in-hospital death, postprocedure myocardial infarction, or stroke, stratified by treatment rendered. Secondary outcomes included variation in length of stay (LOS), cost, and use of each treatment modality. Variation was characterized by the median odds ratio., Results: Among 140,194 hospitalizations for NSTEMI, 35,748 (25.5%) patients received medical therapy alone, 28,678 (20.5%) underwent angiography without revascularization, 58,383 (41.6%) underwent PCI, and 17,385 (12.4%) underwent CABG. Despite adjusting for patient- and hospital-related factors, 2 similar patients were 25% more likely to experience the composite primary outcome following PCI and 45% more likely following CABG at 1 randomly selected hospital than at another. Significant hospital-level variations in LOS and cost were also apparent following each treatment modality., Conclusions: In a large national analysis of hospitalizations for NSTEMI, significant variation was observed in clinical outcome, LOS, and cost associated with each treatment modality, despite adjustment for patient- and hospital-related factors., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© 2022 The Authors.)

Patients who underwent transcatheter edge-to-edge repair (TEER) for mitral regurgitation with atrial fibrillation (AF) at baseline have higher mortality than those without AF. Data on new-onset AF (NOAF) after TEER are limited. Using the 2016 to 2018 Nationwide Readmissions Database, we identified a cohort of patients who underwent TEER and classified them into 3 groups based on AF presence during the study period. The primary end point was the incidence and timing of NOAF up to 6 months after TEER. Logistic regression modeling identified independent predictors of NOAF at readmission. Of the 6,861patients that underwent TEER, 4,134 (59.9%) had AF at baseline, and 239 (3.5%) developed NOAF. Median time-to-NOAF admission was 47 days (interquartile range 16 to 113), and 37% of patients with NOAF presented within 30 days after TEER. Patients with NOAF experienced costlier and longer index-TEER hospitalization and had more co-morbidities. Chronic kidney disease (odds ratio [OR] 1.51, 95% confidence interval [CI] 1.03 to 2.20), fluid and electrolyte disorders (OR 1.59, 95% CI 1.01 to 2.52), and heart failure (OR 1.86, 95% CI 1.01 to 3.44) were identified as independent predictors of NOAF. Hypertensive complications and heart failure were the leading causes of readmission. In conclusion, those patients that developed NOAF after TEER tended to be an overall sicker group at baseline compared with the remainder of the study cohort. These data, obtained from a nationally representative cohort, highlight a particular group of patients subject to developing NOAF and their association with increased rehospitalization in the post-TEER setting. Predictors of NOAF can be screened for during TEER workup to identify patients at increased risk., Competing Interests: Disclosures Dr. Khera is a consultant, speaker, and proctor for Medtronic; a consultant for Terumo, Abbott, and Boston Scientific; and a speaker for Zoll Medical. Dr. Elmariah received research grants from Edwards Lifesciences, Medtronic, and Abbott Vascular and is also a consultant for Edwards Lifesciences. The remaining authors have no conflicts of interest to declare., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Objective: To summarize the existing evidence on the acute response of low-load (LL) resistance exercise (RE) with blood flow restriction (BFR) on hemodynamic parameters., Data Sources: MEDLINE (via PubMed), EMBASE (via Scopus), SPORTDiscus, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science and MedRxiv databases were searched from inception to February 2022., Review Methods: Cross-over trials investigating the acute effect of LLRE + BFR versus passive (no exercise) and active control methods (LLRE or HLRE) on heart rate (HR), systolic (SBP), diastolic (DBP) and mean (MBP) blood pressure responses., Results: The quality of the studies was assessed using the PEDro scale, risk of bias using the RoB 2.0 tool for cross-over trials and certainty of the evidence using the GRADE method. A total of 15 randomized cross-over studies with 466 participants were eligible for analyses. Our data showed that LLRE + BFR increases all hemodynamic parameters compared to passive control, but not compared to conventional resistance exercise. Subgroup analysis did not demonstrate any differences between LLRE + BFR and low- (LL) or high-load (HL) resistance exercise protocols. Studies including younger volunteers presented higher chronotropic responses (HR) than those with older volunteers., Conclusions: Despite causing notable hemodynamic responses compared to no exercise, the short-term LL resistance exercise with BFR modulates all hemodynamic parameters HR, SBP, DBP and MBP, similarly to a conventional resistance exercise protocol, whether at low or high-intensity. The chronotropic response is slightly higher in younger healthy individuals despite the similarity regarding pressure parameters., (© 2022 Scandinavian Society of Clinical Physiology and Nuclear Medicine. Published by John Wiley & Sons Ltd.)

Patients have demonstrated a growing interest in using wearable devices, particularly smartwatches, to monitor and improve their cardiovascular wellness. Wearable devices are now one of the fastest growing sectors of the technology industry, and big technology companies, such as Apple (Apple Watch), Google (Fitbit), and Samsung (Galaxy), have engineered smartwatch features that are capable of monitoring biometrics, such as heart rhythm, heart rate, blood pressure, and sleep. These devices hold significant potential to impact the relation between cardiologists and their patients, but concerns exist about device trustworthiness to detect pertinent data points and deliver alerts with accuracy. How these devices' features will interplay with cardiologists' workflow has also yet to be defined and requires thoughtful implementation. Furthermore, the success of smartwatches as medical devices is dependent on patients' continuous use. Keeping patients engaged with their devices through leveraging behavioral factors may lead to achieving and optimizing healthcare goals. Socioeconomic disparities and privacy concerns are other barriers in the path forward. Cardiovascular professional societies are uniquely poised to help impact how these devices are eventually accepted and used in everyday practice. In conclusion, engagement and collaboration with big tech companies will help guide how this market grows., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Abstract: Diniz, RCR, Tourino, FD, Lacerda, LT, Martins-Costa, HC, Lanza, MB, Lima, FV, and Chagas, MH. Does the muscle action duration induce different regional muscle hypertrophy in matched resistance training protocols? J Strength Cond Res 36(9): 2371-2380, 2022-The manipulation of the muscle action duration (MAD) can influence the instantaneous torque along the range of motion, which can lead to adaptations of regional muscle hypertrophy. The aim of this study was to compare the effects of matched resistance training (RT) on the knee extension machine with different MAD in the cross-sectional area (CSA) responses within the quadriceps femoris (QF) and its muscles. Forty-four subjects were allocated into a control and 3 experimental groups. For a period of 10 weeks, subjects in the experimental groups performed the training protocols that were different only by the MAD: group 5c1e (5s concentric action [CON] and 1s eccentric action [ECC]; group 3c3e (3s CON and 3s ECC) and group 1c5e (1s CON and 5s ECC). Magnetic resonance imaging was performed (before and after the intervention) to determine the relative change (%) in CSA of the QF muscles along proximal (30%), middle (50%), and distal regions (70% distal of the femur). The change in CSA of the rectus femoris at the middle region are greater in 5c1e (6.8 ± 6.5%) and 1c5e (7.4 ± 6.0%) groups than 3c3e (3.4 ± 6.6%) and control groups (0.2 ± 1.8%). In addition, vastus lateralis at the distal region (5c1e = 15.9 ± 11.8%; 1c5e = 14.4 ± 10.0%) presenting greater increases in change of CSA than the others vastus only 5c1e (vastus lateralis [VI] = 5.0 ± 4.7%; vastus medialis [VM] = 4.2 ± 3.2%) and 1c5e groups (VI = 4.7 ± 3.6%; VM = 3.4 ± 3.1%). In conclusion, this study showed that matched RT protocols with different MAD resulted in different region-specific muscle hypertrophic across the individual muscles of QF., (Copyright © 2020 National Strength and Conditioning Association.)

Although the beneficial effects of aerobic training on cardiovascular risk factors are evident, the potential beneficial effect of strength and combined training on these risk factors is controversial. This study aimed to evaluate the effect of aerobic and strength training programmes, performed alone or in combination, on cardiovascular risk factors in sedentary, apparently healthy and non-obese adult men. The study was conducted with 37 subjects who were randomly divided into the following groups: aerobic (AG), combined (ASG), strength (SG) and control (CG). The exercise programmes were performed three times a week and lasted approximately 50 minutes. Dietary intake, anthropometry, blood pressure, muscular strength, aerobic capacity, lipid profile and glycaemic control were assessed before and after 12 weeks of the intervention. One-way analysis of variation (ANOVA) for baseline, and ANOVA for repeated measures were used to assess differences between the initial and final time points of the four groups. Changes in blood pressure and glycaemic control were not significant in any of the groups. No differences were observed in LDL-C between training groups. HDL-C increased significantly only in the AG. In conclusion, if minimal changes in the lipid profile are needed, an aerobic training programme can provide possible benefits for HDL-C in apparently healthy and non-obese adult men., Competing Interests: The authors declare no conflict of interest., (Copyright © Biology of Sport 2022.)

The study compared changes in strength and regional muscle hypertrophy between different ranges of motion (ROM) in the knee extension exercise. Forty-five untrained women were randomized to either a control group or to perform the exercise in one of the following 4 groups (0°=extended knee): Full ROM (FULL ROM : 100°-30° of knee flexion); Initial Partial ROM (INITIAL ROM : 100°-65°); Final Partial ROM (FINAL ROM : 65°-30°); Varied ROM (VAR ROM : daily alternation between the ROM of INITIAL ROM and FINAL ROM ). Pre- and post-training assessments included one repetition maximum (1RM) testing in the ROM corresponding to the initial, final and full ROM, and measurement of cross-sectional areas of the rectus femoris and vastus lateralis muscles at 40%, 50%, 60% and 70% of femur length in regard to regional muscle hypertrophy. Results showed that the INITIAL ROM group presented a greater relative increase than all groups at 70%, and at 50% and 60% the increases were greater than FINAL ROM , FULL ROM , and non-training control (CON) groups. Moreover, FINAL ROM group presented similar changes compared to the CON group at 60% and 70%. In regard to 1RM, FINAL ROM and INITIAL ROM groups presented greater relative increases at the ROM trained, and no group showed greater increases than VAR ROM or INITIAL ROM , regardless the ROM tested. In conclusion, partial ROM training in the initial phase of the knee extension exercise promoted greater relative hypertrophy in certain muscle regions than training in other ROM configurations, and no group promoted a greater 1RM increase than VAR ROM group, which showed similar 1RM increases in the different ROMs tested.

Background: Percutaneous left atrial appendage occlusion (LAAO) devices have emerged as alternatives to anticoagulation for embolic stroke prevention in patients with non-valvular atrial fibrillation (NVAF). The left atrial appendage is known to produce vasoactive neuroendocrine hormones involved in cardiovascular homeostasis. The hemodynamic impact of LAA occlusion on cardiac function remains poorly characterized., Methods: This is a single-center, retrospective study of sixty-seven consecutive patients who received LAAO utilizing the WATCHMAN device from May 2017 to June 2019. All patients received a comprehensive 2D transthoracic echocardiogram (TTE) prior to the procedure and a post-procedural TTE. 2D echocardiographic pre-/post-procedural measurements including left ventricular ejection fraction, tricuspid regurgitation, estimated pulmonary artery pressure, diastolic parameters, and left atrial and right ventricular strain were statistically analyzed using the paired t-test., Results: Seventy percent of study patients were male with an overall mean age of 73.0 ± 9.0 years. Analysis of post-procedural LAAO revealed statistically significant improvement in left ventricular ejection fraction (52.4 ± 12.6 vs. 56.7 ± 12.7, p < 0.001), an increase in mitral E/e' (14.1 ± 6.5 vs. 18.3 ± 10.8, p < 0.001), and a decrease right ventricular global longitudinal strain (RVGLS) (- 17.5 ± 4.6 vs. - 19.6 ± 5.7, p = 0.027) as compared to pre-procedural TTE. Peak left atrial longitudinal strain (PALS) improved post-LAAO (20.6 ± 12.2 to 22.9 ± 12.9, p = 0.040) with adjustment for cardiac arrhythmias. Post-LAAO, heart failure hospitalizations occurred in 23.9% of patients., Conclusions: Percutaneous LAAO results in real-time atrial and ventricular hemodynamic changes as assessed by echocardiographic evaluation of LV filling pressures (E/e'), PALS, RVGLS, and LVEF., (© 2021. Springer Science+Business Media, LLC, part of Springer Nature.)

Abstract: Martins-Costa, HC, Lacerda, LT, Diniz, RCR, Lima, FV, Andrade, AGP, Peixoto, GH, Gomes, MC, Lanza, MB, Bemben, MG, and Chagas, MH. Equalization of training protocols by time under tension determines the magnitude of changes in strength and muscular hypertrophy. J Strength Cond Res 36(7): 1770-1780, 2022-The aim of this study was to investigate the effects of 2 training protocols equalized by tension (TUT) on maximal strength (1 repetition maximum [RM]), regional cross-sectional areas (proximal, middle, and distal), and total cross-sectional areas (sum of the regional cross-sectional areas) of the pectoralis major and triceps brachii muscles. Thirty-eight men untrained in resistance training participated in the study and were allocated under 3 conditions: Protocol 3s (n = 11; 12 repetitions; 3s repetition duration), Protocol 6s (n = 11; 6 repetitions; 6s repetition duration), and Control (n = 11; no training). Training protocols (10 weeks; bench press exercise) were equated for TUT (36 seconds per set), number of sets (3-4), intensity (50-55% of 1RM), and rest between sets (3 minutes). Analysis of variance was used to examine a percentage change in variables of interest across the 3 groups with an alpha level of 0.05 used to establish statistical significance. Protocols 3s and 6s showed no differences in the increase of total and regional muscle cross-sectional areas. There were no differences in regional hypertrophy of the pectoralis major muscle. In the triceps brachii muscle, the increase in distal cross-sectional area was greater when compared with the middle and proximal regions. Both experimental groups had similar increases in the 1RM test. In conclusion, training protocols with the same TUT promote similar strength gains and muscle hypertrophy. Moreover, considering that the protocols used different numbers of repetitions, the results indicate that training volumes cannot be considered separately from TUT when evaluating neuromuscular adaptations., (Copyright © 2021 National Strength and Conditioning Association.)

This study is aimed at evaluating the profile of inflammatory markers and components of redox regulation in untrained women after 10 weeks of resistance training using equalized protocols but different muscle action duration (MAD). Twenty-two women underwent progressive resistance training exercising the knee extensor muscles for 10 weeks-3x/week, with 3-5 sets of 6 repetitions at 50% of the 1 repetition maximum strength test (1RM), with a rest of 180 s between the series, following the training protocol (i) 5 s of concentric muscle action for 1 s of eccentric muscle action (5C-1E) and (ii) 1 s of concentric muscle action for 5 s of eccentric muscle action (1C-5E). Quadriceps muscle hypertrophy maximum strength (1RM) and redox regulation/muscle damage/inflammatory markers (CAT, SOD, TBARS, FRAP, CH, LDH, CXCL8, and CCL2) were evaluated. Plasma markers were evaluated before and 30 minutes after the first and last training sessions. A similar gain in hypertrophy and maximum strength was observed in both groups. However, in the 5C-1E, a significant major effect was observed for SOD ( F 1.19 = 10.480, p = 0.004) and a significant major time effect, with a reduction in the last training session, was observed for CXCL8 ( F 1.37 = 27.440, p < 0.001). In conclusion, similar protocols of resistance training, with different MAD, produced similar inflammatory and adaptive responses to strength training. As the training load is progressive, the maintenance of this inflammatory and redox regulation profile suggests an adaptive response to the proposed strength training., Competing Interests: The authors declare no conflicts of interest regarding the publication., (Copyright © 2022 Kelerson Mauro de Castro Pinto et al.)

This study investigated the impact of performing two equalized resistance training (RT) protocols for 10 weeks that differ only by repetition duration and number in the force-position and EMG-position relationship. Participants performed an equalized (36 s of time under tension; 3-4 sets; 3 min between sets; 50-55% of one-repetition maximum; 3× week) RT intervention on the bench press and the only different change between protocols was repetition number (RN; 12 vs.6) or duration (RD; 3 s vs. 6 s). Two experimental groups (RN 12 RD 3 , n  = 12; and RN 6 RD 6 , n  = 12) performed the RT, while one group was the control (Control, n  = 11). Maximal isometric contractions at 10%, 50% and 90% of total bench press range of motion were performed pre- and post-RT, while electromyography was recorded. It demonstrated an increase in isometric force (+14% to 24%, P  < 0.001) shifting up the force-position relationship of the training groups after RT, although no difference was between training groups compared to the Control. Neuromuscular activation from pectoralis major presented an increase after training for both RT groups (+44%; P  < 0.001) compared to the Control. However, although not significantly different, triceps brachii also presented an increase depending on the protocol (+25%). In conclusion, 10 weeks of an equalized RT with longer RN and shorter RD (or opposite) similarly increases the ability to produce maximal isometric force during the bench exercise across different angles, while neuromuscular activation of the pectoralis major partially explained the shift-up of the force-position relationship after training.

Muscle volume (MV) and anatomical cross-sectional area (CSA) are used as measures of muscle-size, but determining these from magnetic resonance imaging (MRI) is a very time-consuming process. Additionally, it is unclear if the use of different muscle size assessments (all vs. reduced number of slices images) would impact the muscle size-strength relationship. Thus, this study aimed to investigate if muscle size calculation by using a reduced or all slices images from pectoralis major (PM) would maintain a similar muscle size-strength relationship with bilateral maximal dynamic and isometric contractions on a bench press exercise. Twenty-four healthy males underwent an MRI examination to measure PM muscle size, and maximal isometric and dynamic contractions (by one repetition maximum, 1RM) were performed. Correlations between maximal isometric voluntary force (MVF) and dynamic strength (1RM) with muscle size variables [three images from the largest part of PM (CSA 3MAX ), three images accounting for the shape -first image, middle image, final image- of the PM (CSA 3 ), and MV] were performed. The correlation between 1RM with MV, CSA 3 , and CSA 3MAX were 0.84, 0.832, and 0.727 (p < 0.001), respectively. The correlation between MVF with MV, CSA 3 , and CSA 3MAX were 0.738, 0.733, and 0.604 (p < 0.001), respectively. Overall, PM MV and CSA 3 exhibit a stronger and similar muscle size-strength relationship during maximal dynamic and isometric tests than CSA 3MAX . Therefore, a reduced number of slices (CSA 3 ) could be used as an alternative to considerably reduce the time of analysis without compromise muscle size-strength relationship., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: There are limited contemporary, national data describing diagnostic cardiac catheterization with subsequent percutaneous coronary intervention (ad hoc percutaneous coronary intervention [PCI]) performed by an invasive-diagnostic and interventional (Dx/IC) operator team versus solo interventional operator (solo-IC). Using the CathPCI Registry, this study aimed at analyzing trends and outcomes in ad hoc PCI among Dx/IC versus solo-IC operators., Methods: Quarterly rates (January 2012 to March 2018) of ad hoc PCI cases by Dx/IC and solo-IC operators were obtained. Odds of inhospital major adverse cardiovascular events, net adverse cardiovascular events (ie, composite major adverse cardiovascular event+bleeding), and rarely appropriate PCI were estimated using multivariable regression., Results: From 1077 sites, 1 262 948 patients were included. The number of invasive-diagnostic operators and cases performed by Dx/IC teams decreased from nearly 9% to 5% during the study period. Patients treated by Dx/IC teams were more often White and had fewer comorbidities compared with patients treated by solo-IC operators. Considerable variation existed across sites, and over two-fifths of sites had 0% ad hoc PCI performed by Dx/IC. In adjusted analyses, ad hoc performed by Dx/IC had similar risks of major adverse cardiovascular event (OR, 1.04 [95% CI, 0.97-1.11]) and net adverse cardiovascular events (OR, 0.98 [95% CI, 0.94-1.03]) compared with solo-IC. Rarely appropriate PCI, although low overall (2.1% versus 1.9%) occurred more often by Dx/IC compared with solo-IC (OR, 1.20 [95% CI, 1.13-1.26])., Conclusions: Contemporary, nationwide data from the CathPCI Registry demonstrates the number of Dx/IC operator teams and cases has decreased but that case volume is stable among operators. Outcomes were independent of operator type, which supports current practice patterns. The finding of a higher risk of rarely appropriate PCI in Dx/IC teams should be further studied.

The present study investigated the effect of 10-week matched (range of motion, volume, intensity, rest, and repetition duration) training protocols with varying muscle action duration (MAD) on maximal voluntary isometric contraction (MVIC) test at eight different knee angles and one-repetition maximum (1RM) test after in seated knee extensor machine. Forty women were allocated into one control and three training groups with varying MAD: 5C1E (5s concentric action [CON] and 1s eccentric action [ECC]), 3C3E (3s CON and 3s ECC), and 1C5E (1s CON and 5s ECC). All training groups (5C1E, 3C3E, and 1C5E) showed a greater relative response in 1RM performance than the control group (0.1 ± 3.5%, p ≤ 0.05). The 1C5E group presented greater relative increases in the 1RM performance (22.1 ± 11.6%) compared to 5C1E (13.6 ± 9.2%; p ≤ 0.05) and 3C3E (14.1 ± 5.5%, p ≤ 0.05) groups. The training groups increased the MVIC performance more than the control group (p ≤ 0.05), although there were no significant differences between the training groups. This study demonstrated that isoinertial resistance training protocols with shorter CON MAD showed greater maximum dynamic strength performance response than matched training protocols with other MAD configurations. However, the configuration of MAD did not induce angle-specificity to increase the maximum isometric strength.

Background: Transcatheter closure of patent foramen ovale (PFO) in patients with cryptogenic stroke reduces the rate of recurrent events. Although presence of thrombophilia increases the risk for paradoxical emboli through a PFO, such patients were excluded from large randomized trials., Objectives: We compared the safety and efficacy of percutaneous PFO closure in patients with and without a hypercoagulable state., Methods: Data from 800 consecutive patients undergoing percutaneous PFO closure in our medical center were analyzed. All patients were independently evaluated by specialists in neurology, cardiology, hematology, and vascular medicine. A post-procedural treatment of at least 3 months of anticoagulation was utilized in patients with thrombophilia. Follow-up events included death, recurrent neurological events, and the need for reintervention for significant residual shunt., Results: A hypercoagulable state was found in 239 patients (29.9%). At median follow-up of 41.9 months, there were no differences in the frequencies of stroke or transient ischemic attack between patients with or without thrombophilia (2.5% in non-hypercoagulable group vs. 3.4% in hypercoagulable group, log-rank test p = 0.35). There were no significant differences in baseline demographics, echocardiographic characteristics, procedural success, or complications between groups., Conclusion: Percutaneous PFO closure is a safe and effective therapeutic approach for patients with cryptogenic stroke and an underlying hypercoagulable state., (© 2021 Wiley Periodicals LLC.)

Background: Noninvasive Ventilation (NIV) is a well-established treatment for Acute Respiratory Failure (ARF) in hematological cancer. However, the NIV impact on mortality in patients with solid tumors is unclear., Objective: To define the factors associated with NIV failure and mortality and to describe the mortality risk of patients with solid tumors requiring NIV for ARF treatment in the intensive care unit (ICU)., Methods: A retrospective cohort study of patients with solid tumors admitted into an ICU between Jan 2016 and Dec 2017, for cancer treatment, with ARF diagnosis that had used the NIV as first-line treatment. Our primary outcome was ICU and in-hospital mortality. The secondary outcome was NIV failure. A Cox proportional hazards regression was used to identify variables associated with mortality and NIV failure. Kaplan-Meier analyses were performed to demonstrate cumulative survival., Results: A total of 226 patients with solid tumors were included. The ICU and hospital mortality rates were 57.5% and 69.5%, respectively. NIV failed in 52.2% of the patients. The use of vasopressors (HR 2.48 [95% CI: 1.43-4.30] p = 0.001), baseline lactate (HR 1.20 [95% CI: 1.07-1.35] p = 0.003), baseline PaO 2 /FiO 2 ratio (HR1.33 [1.11-1.55] p = 0.002), and NIV success (HR0.17 [95% CI: 0.10-0.27] p = 0.005) was independently associated with hospital mortality. The use of vasopressors (HR 2.58 [95% CI: 1.41-4.73] p = 0.02), NIV duration (HR 0.93 [95% CI: 0.89-0.97] p = 0.003), and baseline lactate (HR 1.13 [95% CI: 1.06-1.20] p = 0.001) was associated with NIV failure., Conclusions: NIV failure was independently associated with an increase in both ICU and hospital mortality rates. In patients with NIV therapy indication, the duration of this intervention was associated with NIV failure., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH, DE part of Springer Nature.)

Heart failure (HF) remains the most common major cardiovascular complication arising in pregnancy and the postpartum period. Mothers who develop HF have been shown to experience an increased risk of death as well as a variety of adverse cardiac and obstetric outcomes. Recent studies have demonstrated that the risk to neonates is significant, with increased risks in perinatal morbidity and mortality, low Apgar scores, and prolonged neonatal intensive care unit stays. Information on the causal factors of HF can be used to predict risk and understand timing of onset, mortality, and morbidity. A variety of modifiable, nonmodifiable, and obstetric risk factors as well as comorbidities are known to increase a patient's likelihood of developing HF, and there are additional elements that are known to portend a poorer prognosis beyond the HF diagnosis. Multidisciplinary cardio-obstetric teams are becoming more prominent, and their existence will both benefit patients through direct care and increased awareness and educate clinicians and trainees on this patient population. Detection, access to care, insurance barriers to extended postpartum follow-up, and timely patient counseling are all areas where care for these women can be improved. Further data on maternal and fetal outcomes are necessary, with the formation of State Maternal Perinatal Quality Collaboratives paving the way for such advances.

This study determined the time-course of recovery after resistance training (RT) sessions and the association between changes in performance with changes in biomechanical, physiological and perceptual parameters. After a 4-week familiarization period, 14 resistance-trained males performed 3 experimental conditions, each one including 2 sessions with a recovery interval of 24, 48 h or 72 h, in a randomized order. RT sessions consisted of 5 sets of 8-10RM on squat and leg press exercises. The resistance was equal for the 2 sessions of each condition and repetitions were performed until concentric failure. Volume load (VL) and first set volume load (FSVL) were compared between sessions. Tests before each session included countermovement jump (CMJ), maximal voluntary isometric contraction (MVIC), creatine kinase (CK) and delayed onset muscle soreness (DOMS). (2 × 3) ANOVA with effect sizes (ES) assessed the time-course of recovery and Kendall test the correlation between variables ( α  = 0.05). Significant interaction was observed for all variables, except for CK, where a condition main effect occurred. Comparisons between post and pre-intervals showed VL ( p  = 0.011;ES = -0.90) decreased for 24 h condition, while FSVL remained decreased for 48 h ( p  = 0.031;ES = -0.63) and DOMS increased ( p  = 0.001;ES = 3.52). CMJ ( p  = 0.025;ES = 0.25) and MVIC ( p  = 0.031;ES = 0.14) performance increased at 72 h. FSVL ( r  = 0.424), CMJ ( r  = 0.439), MVIC ( r  = 0.389) and DOMS ( r  = -0.327) were significantly correlated with VL ( p  < 0.05). Time-course of VL showed the necessity of at least 48 h for the reestablishment of performance, though better perceptual responses were evident at 72h. Thus, both recovery intervals may be beneficial after lower-limbs RT until concentric failure, though chronic effects still need to be investigated.

Background: This study investigated the effects of two 14-week resistance training protocols with different repetition duration (RD) performed to muscle failure (MF) on gains in strength and muscle hypertrophy as well as on normalized electromyographic (EMG) amplitude and force-angle relationships., Methods: The left and right legs of ten untrained males were assigned to either one of the two protocols (2-s or 6-s RD) incorporating unilateral knee extension exercise. Both protocols were performed with 3-4 sets, 50-60% of the one-repetition maximum (1RM), and 3 min rest. Rectus femoris and vastus lateralis cross-sectional areas (CSA), maximal voluntary isometric contraction (MVIC) at 30 o and 90 o of knee flexion and 1RM performance were assessed before and after the training period. In addition, normalized EMG amplitude-angle and force-angle relationships were assessed in the 6 th and 39 th experimental sessions., Results: The 6-s RD protocol induced larger gains in MVIC at 30 o of knee angle measurement than the 2-s RD protocol. Increases in MVIC at 90 o of knee angle, 1RM, rectus femoris and vastus lateralis CSA were not significant between the 2-s and 6-s RD protocols. Moreover, different normalized EMG amplitude-angle and force-angle values were detected between protocols over most of the angles analyzed., Conclusion: Performing longer RD could be a more appropriate strategy to provide greater gains in isometric maximal muscle strength at shortened knee positions. However, similar maximum dynamic strength and muscle hypertrophy gains would be provided by protocols with different RD., Competing Interests: The authors declare there are no competing interests., (©2021 Lacerda et al.)

This work aims to address the design and control challenges caused by the integration of phenomena and the loss of degrees of freedom (DOF) that occur in the intensification of membrane reactor units. First, a novel approach to designing membrane reactor units is proposed. This approach consists of designing smaller modules based on specific phenomena such as heat exchange, reactions, and mass transport and combining them in series to produce the final modular membrane-based unit. This approach to designing membrane reactors is then assessed using a process operability analysis for the first time to maximize the operability index, as a way of quantifying the operational performance of intensified processes. This work demonstrates that by designing membrane reactors in this way, the operability of the original membrane reactor design can be significantly improved, translating to an improvement in achievability for a potential control structure implementation.

Objectives: Despite advancements in resistance training (RT) methods, the acute metabolic and neuromuscular responses to time under tension (TUT) and load remains poorly understood. The aim of the present study was to investigate how TUT or resistance load impact muscular activation and blood lactate during an RT session., Design: A randomized cross-over design., Methods: Participants performed a squat exercise in three different conditions: baseline protocol (B PRO ; three sets of eight repetitions with four second repetitions at 60% of 1RM) long duration protocol (LD PRO : six second repetitions) and high load protocol (HL PRO : 70% 1RM)., Results: Muscular activation of the vastus lateralis and biceps femoris, and blood lactate were assessed. Blood lactate was ∼19% and ∼26% higher after set one and three in LD PRO compared to B PRO (P≤0.011) and ∼17% higher for LD PRO compared to HL PRO (P=0.002). Additionally, blood lactate was ∼17% higher for HL PRO compared to B PRO after the third set of exercise (P=0.003). Vastus lateralis activation was ∼10% higher for HL PRO compared to B PRO and LD PRO for sets one and two. Biceps femoris activation was ∼17% higher for HL PRO compared to B PRO for set one (P= 0.023) while for set two HL PRO was greater than B PRO and LD PRO (∼19% and ∼14%, respectively; P≤0.007)., Conclusions: Squatting with higher TUT caused a greater impact on the metabolic responses than lower TUT or higher loads, whereas an increase in training load resulted in greater muscle activation than higher TUT or lower training load., (Copyright © 2020 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.)

Urocanic acid is a chromophore found in the skin that has been identified as an important immunosuppressant and carcinogenesis mediator through its photoisomerization from trans to cis form induced by ultraviolet radiation. Research on analytical methods that explore urocanic acid isomerization is indispensable to fully understand the deleterious effects mediated by this biomarker. In this context, the current relevant analytical methods for determination of these isomers in human samples are summarized in this review. The methods presented here are applicable to human samples collected by noninvasive methods (or minimally invasive), encompassing an array of analytical techniques, including high-performance capillary electrophoresis, confocal Raman spectroscopy, gas chromatography, high-performance liquid chromatography, and mass spectrometry, among others. Developed high-performance liquid chromatography methods have proven to be advantageous, allowing noninvasive collections for in vivo analysis and the confocal Raman, specially, for real-time analysis. Among all these methods, high-performance liquid chromatography is the most investigated one with mass spectrometry or ultraviolet detector, and the mass spectrometry detector being the most studied in the last years, demonstrating high sensitivity, very low detection limits, and accurate identification, especially for clinical investigations., (© 2020 Wiley-VCH GmbH.)

Background Pregnancy increases the risk of acute myocardial infarction (AMI). The purpose of this study was to examine timing and risk factors for AMI in pregnancy and poor outcome. Methods and Results National Inpatient Sample (2003-2015) was screened in pregnancy, labor and delivery, and postpartum. There were 11 297 849 records extracted with 913 instances of AMI (0.008%). One hundred eleven (12.2%) women experienced AMI during labor and delivery, 338 (37.0%) during pregnancy and most during the postpartum period (464; 50.8%). The prevalence of AMI in pregnancy has increased ( P =0.0005). Most major adverse cardiovascular and cerebrovascular events occurred in the postpartum period (63.5%). Inpatient mortality was 4.5%. Predictors of AMI include known coronary artery disease (odds ratio [OR], 517.4; 95% CI, 420.8-636.2), heart failure (OR, 8.2; 95% CI, 1.9-35.2), prior valve replacement (OR, 6.4; 95% CI, 2.4-17.1), and atrial fibrillation (OR, 2.7; CI, 1.5-4.7; P <0.001). Risk factors of traditional atherosclerosis including hyperlipidemia, obesity, tobacco history, substance abuse, and thrombophilia were identified ( P <0.001). Gestational hypertensive disorders (eclampsia OR, 6.0; 95% CI, 3.3-10.8; preeclampsia OR, 3.2; 95% CI, 2.5-4.2) were significant risk factors in predicting AMI. Risk factors associated with major adverse cardiovascular and cerebrovascular events included prior percutaneous coronary intervention (OR, 6.6; 95% CI, 1.4-31.2) and pre-eclampsia (OR, 2.3; 95% CI, 1.3-3.9). Conclusions AMI is associated with modifiable, nonmodifiable, and obstetric risk factors. These risk factors can lead to devastating adverse outcomes and highlight the need for risk factor modification and public health resource initiatives toward the goal of decreasing AMI in the pregnant population.

Background: Randomized clinical trial data have demonstrated catheter ablation (CA) as a viable treatment modality for atrial fibrillation (AF). Patients with heart failure (HF) undergoing AF CA appear to derive improvements in quality of life and mortality compared to those treated with medical therapy (MT). Contemporary national data on 30-day readmissions after CA compared to MT among patients with HF are lacking., Methods: From the 2016 Nationwide Readmissions Databases, 749 776 (weighted national estimate: 1 421 673) AF HF patients were identified of which 2204 (0.3%) underwent CA and 747 572 (99.7%) received MT. Propensity matching balanced baseline clinical characteristics. Thirty-day readmission rates, causes, predictors, and costs of 30-day readmission were compared., Results: Among both the unmatched and matched cohorts, 30-day readmissions were lower for patients treated with CA compared to MT (16.8% vs 20.1%, P < .001 and 16.8% vs 18.8%, P = .020). CA was associated with reduced risk of readmission compared to MT (odds ratio 0.86, 95% confidence interval [CI]: 0.77-0.97). HF exacerbation and arrhythmias were the most common cause for 30-day readmission after CA. CA costs were higher during index hospitalization but similar to MT during readmission among the matched cohort ($15 858 ± $21 636 vs $16 505 ± $29 171, P = .67). Predictors of readmission were largely nonmodifiable risk factors among both the CA and MT groups., Conclusions: Nearly one in six patients with HF is readmitted within 30-days after undergoing CA. In propensity matched analyses, CA was associated with decreased rate and risk for readmission compared to MT. CA has higher index hospitalization costs, but lower readmission costs., (© 2020 Wiley Periodicals LLC.)

Objective: Determine the rates, reasons, predictors, and costs of 30-day readmissions following transcatheter mitral valve repair (TMVR) versus surgical mitral valve repair (SMVR) in the United States., Background: Data on 30-day readmissions after TMVR are limited., Methods: High-risk patients with mitral regurgitation (MR) undergoing TMVR or SMVR were identified from the 2014-2015 Nationwide Readmissions Databases. Multivariable stepwise regression models were used to identify independent predictors of 30-day readmission. Risk of 30-day readmission was compared between the two groups using univariate and propensity score adjusted regression models., Results: Among 8,912 patients undergoing mitral valve repair during 2014-2015 (national estimate 17,809), we identified 7,510 (84.7%) that underwent SMVR and 1,402 (15.3%) that underwent TMVR. Thirty-day readmission rates after SMVR and TMVR were 10.7% and 11.7%, respectively (unadjusted OR 1.11, 95% CI 0.89-1.39, p = .35). After propensity score adjustment, TMVR was associated with a lower risk of 30-day readmissions compared with SMVR (adjusted OR 0.70, 95% CI 0.51-0.95, p = .02). Heart failure and arrhythmias were the leading cardiac reasons for readmission. Anemia and fluid and electrolyte disorder were independent predictors of 30-day readmission after TMVR. Demographics, comorbidities, and length of stay were independent predictors of 30-day readmission after SMVR., Conclusions: One in 10 patients are readmitted within 30 days following TMVR or SMVR. Approximately half of the readmissions are for cardiac reasons. The predictors of 30-day readmission are different among patients undergoing TMVR and SMVR, but can be easily screened for to identify patients at highest risk for readmission., (© 2019 Wiley Periodicals, Inc.)

This study compared the electromyographic response, the blood lactate concentration (BLC), and the maximum number of repetitions (MNR) between protocols of different concentric/eccentric duration taken to muscle failure. This comparison may help to understand how different concentric/eccentric duration may influence performance and the central and metabolic responses in trained men. Seventeen strength-trained men performed two protocols in a counterbalanced design. Three sets of the Smith bench press exercise were performed to failure at 60% of the one-repetition maximum (1RM) using each protocol (4-s concentric/2-s eccentric [4 s: 2 s]; and 2-s concentric/4-s eccentric [2 s: 4 s]). The normalized root mean square (EMGRMS) and the mean frequency (EMGMF) of the electromyographic signals for the pectoralis major and the triceps brachii were compared in the first, middle, and last repetitions. The BLC was assessed at rest, during and after the test sessions. To compare the EMG and BLC, a 3-way ANOVA with repeated measures with a post hoc Tukey's test was used. To compare the MNR performed across the sets, an ANOVA-type rank test with the Dunn's post hoc test was used. The ANOVA indicated a greater EMGRMS for Protocol 4 s: 2 s in the pectoralis major and a lower EMGMF for Protocol 4 s: 2 s in the triceps brachii at the middle and last repetitions. Both protocols increased the EMGRMS and decreased the EMGMF across repetitions. Despite the results show different levels of activation and neuromuscular fatigue between protocols, the BLC and the MNR were similar., (© 2020 Gustavo Ferreira Pedrosa, Sandra Carvalho Machado, Rodrigo César Ribeiro Diniz, Lucas Túlio de Lacerda, Hugo Cesar Martins-Costa, André Gustavo Pereira de Andrade, Michael Bemben, Mauro Heleno Chagas, Fernando Vitor Lima, published by Sciendo.)

Lacerda, LT, Marra-Lopes, RO, Diniz, RCR, Lima, FV, Rodrigues, SA, Martins-Costa, HC, Bemben, MG, and Chagas, MH. Is performing repetitions to failure less important than volume for muscle hypertrophy and strength? J Strength Cond Res 34(5): 1237-1248, 2020-The aim of this study was to investigate the effects of muscle failure (MF) or not to MF (NMF) training on strength and muscle hypertrophy relative gains (average and individual data). Ten men untrained in resistance training participated in the study. Each leg was allocated in 1 of 2 unilateral training protocols (MF or NMF with equal volume) on knee extension exercise. Both protocols were performed with 3-4 sets, 3 minutes' rest, and 55-60% of one repetition maximum (1RM). Rectus femoris and vastus lateralis muscles cross-sectional area (CSA), maximal muscle strength (1RM and maximal voluntary isometric contraction), and muscular endurance (maximum number of repetition) were assessed before and after 14 weeks. In addition, neuromuscular activation by normalized root mean square of the electromyographic signal (EMGRMS) was measured in 2nd and 35th training sessions. The average results showed that both training protocols were similarly effective in inducing increases in strength and muscle hypertrophy gains. However, individual analysis data suggest that NMF protocol with equal volume may promote similar or even greater muscle hypertrophy (vastus lateralis) and muscular endurance performance when compared with MF protocol. Also, normalized EMGRMS responses analyzed during 2nd and 35th sessions were similar in MF and NMF protocols for rectus femoris and vastus lateralis muscles. In conclusion, MF and NMF protocol conducted with the same total repetition numbers produced similar maximal muscle strength performance and neuromuscular activation. Nevertheless, NMF training could be a more appropriate strategy to increase muscle hypertrophy (vastus lateralis) and muscular endurance performance in untrained individuals when compared with MF.

Background: Contemporary, nationally representative 30-day readmissions data after carotid artery stenting (CAS) and carotid endarterectomy (CEA) are lacking., Methods: Patients undergoing CAS or CEA were identified from the 2013 to 2014 Nationwide Readmissions Databases. Propensity matching was used to balance baseline clinical characteristics. Thirty-day nonelective readmission rates, length of stay, and causes of readmission were compared., Results: Overall, 85 337 (national estimate of 194 332) patients were identified before propensity score matching, 11 490 (13.4%) of whom underwent CAS and 73 847 (86.6%) of whom underwent CEA. Crude 30-day readmission rates were higher for patients treated with CAS than CEA (8.3% versus 6.8%; P <0.001), but these differences were negated in the propensity-matched cohort (n=22 214; 8.4% versus 7.9%, P =0.20), and readmission length of stay was longer for CEA than CAS (2 versus 1 day, respectively; P =0.002). The most common reasons for readmission were neurological and cardiac events; readmission reasons varied by revascularization modality. Readmission due to a stroke or transient ischemic attack was more common among patients treated with CAS than CEA (1.2% versus 0.9%; P =0.042), while readmission for procedural or medical complications occurred more often following CEA than CAS (1.1% versus 0.5%; P <0.001); readmission rates for cardiac causes were similar between groups., Conclusions: Less than 8% of patients are readmitted within 30 days of a carotid revascularization procedure. After adjusting for baseline differences, readmission rates are similar for CAS and CEA although readmission length of stay is longer after the latter. Readmission for neurological causes was more common following CAS while readmission for procedural or medical complications occurred more often following CEA. Higher annual institutional CEA volumes were associated with lower risk for 30-day readmission; in contrast, institutional CAS volumes were not related to readmission risk. These data provide important insights into the short-term, outcomes of patients following carotid artery revascularization.

Whether renal artery stenting (RAS) confers benefit over medical therapy (MT) alone in patients with atherosclerotic renal artery stenosis admitted with acute coronary syndromes (ACS), congestive heart failure (CHF), or hypertensive crisis remains unknown. We identified a nationally-weighted cohort of 116,056 patients from the Nationwide Readmissions Database with a preexisting diagnosis of atherosclerotic renal artery stenosis and an index hospitalization diagnosis of ACS, CHF, or hypertensive crisis, and propensity-matched on the likelihood of undergoing inpatient RAS. Thirty-day readmission rates, index hospitalization complications, hospital lengths-of-stay, and cost were compared between treatment groups. Overall, all-cause, nonelective 30-day readmission rates did not differ between RAS and MT alone (18.2% vs 18.7%, respectively, p = 0.49). RAS was associated with higher index rates of acute kidney injury, major bleeding, transfusion, and vascular complications, and were similar irrespective of index hospitalization diagnosis. Index hospitalization length of stay (6 vs 4 days; p <0.001) and cost ($23,020 vs. $11,459; p <0.001) were higher with RAS. In conclusion, nearly 1-in-5 patients hospitalized with atherosclerotic renal artery stenosis and ACS, CHF, or hypertensive crisis were readmitted within 30-days. Index hospitalization complications occurred more frequently among those treated with RAS than MT alone, but the likelihood of readmission did not differ by treatment strategy., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Our societal needs for greener, economically viable products and processes have grown given the adverse environmental impact and unsustainable development caused by human activities, including chemical releases, exposure, and impacts. To make chemical processes safer and more sustainable, a novel sustainability-oriented control strategy is developed in this work. This strategy enables the incorporation of online sustainability assessment and process control with sustainability constraints into chemical process operations. Specifically, U.S. Environmental Protection Agency (EPA)'s GREENSCOPE (Gauging Reaction Effectiveness for the ENvironmental Sustainability of Chemistries with a multi-Objective Process Evaluator) tool is used for sustainability assessment and environmental release minimization of chemical processes. The multivariable GREENSCOPE indicators in real time can be represented using a novel visualization method with dynamic radar plots. The analysis of the process dynamic behavior in terms of sustainability performance provides means of defining sustainability constraints for the control strategy to improve process sustainability aspects with lower scores. For the control tasks, Biologically Inspired Optimal Control Strategy (BIO-CS) is implemented with sustainability constraints so that the control actions can be calculated considering the sustainability performance. This work leads to a significant step forward towards augmenting the capability of process control to meet future demands on multiple control objectives (e.g., economic, environmental, and safety related). The effectiveness of the proposed framework is illustrated via two case studies associated with a fermentation system. The results show that the proposed control strategy can effectively drive the system to the desired setpoints while meeting a preset sustainability constraint and improving the transient sustainability performance by up to 16.86% in terms of selected GREENSCOPE indicators., Competing Interests: Conflicts of Interest: The authors declare no conflict of interest.

The present study compared neuromuscular activation, measured by surface electromyography (EMG) amplitude [measure by EMG peak (EMG PEAK )] and range of motion (ROM) where EMG PEAK occurred between two training protocols, matched by time under tension, but with a different number and duration of repetitions. Sixteen recreationally trained males performed 2 training protocols with 3 sets, 180 s of rest with 60% of one-repetition maximum(1RM) on the bench press performed in a Smith machine. Protocol A consisted of 6 repetitions with a repetition duration of 6 s and protocol B consisted of 12 repetitions with a repetition duration of 3 s. EMG activity of anterior deltoid, pectoralis major and triceps brachii muscles were recorded. The results showed a general higher EMG amplitude (regardless of the muscle) in protocol B (p = 0.010), and pectoral and triceps brachii consistently presented higher neuromuscular activation than anterior deltoid at both protocols (p = 0.007). Additionally, the ROM where EMG PEAK occurred in triceps brachii was in the middle of the concentric action (~50% of ROM), this occurred in the first half of the same action (~24% of ROM) in the other muscles. In conclusion, protocol B demonstrated an increased EMG amplitude over protocol A, although both protocols responded similarly by achieving the highest EMG amplitude at same ROM among the muscles analysed., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

The integration of state estimation and control is a promising approach to overcome challenges related to unavailable or noisy online measurements and plant-model mismatch. Extended Kalman filter (EKF) and moving horizon estimator (MHE) are widely used methods that have complementary features. EKF provides fast estimation and MHE optimal performance. In this paper, a novel hierarchical EKF/MHE approach combined with a dynamic matrix controller (DMC), denoted as EKF/MHE-DMC, is proposed for process monitoring and dissolved oxygen control in airlift bioreactors. The approach is successfully tested in simulated cultivations of Escherichia coli for recombinant protein production, considering specific scenarios of step set point tracking, step disturbance rejection, plant-model mismatch, and measurement noise. Results also show that, given a model that describes the measured dissolved oxygen precisely, as assumed in this study for the in silico experiments, the EKF/MHE-DMC approach is able to estimate the cell, protein, substrate, and dissolved oxygen concentrations based only on the measurement of the latter, reducing the estimation error by 93.8% when compared to a benchmark case employing EKF and DMC. The general structure of the proposed EKF/MHE-DMC framework could be adapted for implementation on other relevant bioprocess systems employing their derived process models.

Carbamide peroxide is the popular home dental whitening agent. However, it has critical stability. Nanoparticles have been applied to develop products with advantages properties as better efficacy and stability increase. The aim of this study was the characterization of carbamide peroxide polymeric nanoparticles, their bleaching efficacy, effects on pulp damage and stability evaluation. Particle size demonstrated a spherical morphology and bimodal distribution (11 and 398 nm). Nanoparticles presented high entrapment efficiency (98.94%) and the zeta potential value was slightly positive (+10.26 mV). Regardless of the zeta potential, the steric effect may contribute to carbamide peroxide nanoparticle stabilization. The stability studies conducted at room temperature suggested that carbamide peroxide nanoparticles could maintain all the parameters evaluated (size, polydispersity index, zeta potential, entrapment efficiency, pH and content) for at least 90 days. Instability index was determined by dispersion analyzer (LUMiSizer ® ), was 0.018, and the light transmission profile did not present sedimentation. Carbamide peroxide nanoparticles were able to prevent thermal degradation and photostability. Clinical efficacy of the whitening gels was obtained by color change in the spectrophotometer and the results showed that all the evaluated gels containing the nanoparticles (0, 1, 2 and 5% of real carbamide peroxide) were effective at bleaching after 2 h of home whitening treatment (during 30 days). After the treatment, the extracted teeth showed no in situ pulp damage by histological evaluation. The nanotechnology strategy of converting carbamide peroxide into polymeric nanoparticles revealed a new product with improved stability, a good approach for carbamide peroxide delivery., (Copyright © 2019. Published by Elsevier B.V.)

There are limited contemporary data on readmission after revascularization for chronic mesenteric ischemia (CMI). This study aimed to determine the rates, reasons, predictors, and costs of 30-day readmission after endovascular or surgical revascularization for CMI. Patients with CMI discharged after endovascular or surgical revascularization during 2013 to 2014 were identified from the Nationwide Readmissions Database. The rates, reasons, length of stay, and costs of 30-day all-cause, non-elective, readmission were determined using weighted national estimates. Independent predictors of 30-day readmission were determined using hierarchical logistic regression. Among 4671 patients with CMI who underwent mesenteric revascularization, 19.5% were readmitted within 30 days after discharge at a median time of 10 days. More than 25% of readmissions were for cardiovascular or cerebrovascular conditions, most of which were for peripheral or visceral atherosclerosis and congestive heart failure. Independent predictors of 30-day readmission included non-elective index admission, chronic kidney disease (CKD), and discharge to home healthcare or to a skilled nursing facility. Revascularization modality did not independently predict readmission. In a nationwide, retrospective analysis of patients with CMI undergoing revascularization, approximately one in five were readmitted within 30 days. Predictors were largely non-modifiable and included non-elective index admission, CKD, and discharge disposition.

Lacerda, LT, Costa, CG, Lima, FV, Martins-Costa, HC, Diniz, RCR, Andrade, AGP, Peixoto, GHC, Bemben, MG, and Chagas, MH. Longer concentric action increases muscle activation and neuromuscular fatigue responses in protocols equalized by repetition duration. J Strength Cond Res 33(6): 1629-1639, 2019-The aim of this study was to investigate the impact of protocols equalized by the repetition duration but composed of different concentric (CON) and eccentric (ECC) durations on muscle activation and neuromuscular fatigue. Seventeen males with previous experience in resistance training performed 3 training protocols (A - 2 second CON: 4 second ECC; B - 3 second CON: 3 second ECC; and C - 4 second CON: 2 second ECC) with the Smith machine bench press exercise, all with 3 sets, 6 repetitions, 3 minutes' rest, and 60% of 1RM. The normalized root mean square of the electromyographic signal (EMGRMS) and mean frequency electromyography (EMGMF) for pectoralis major and triceps brachii muscles were calculated for second and fifth repetitions in each set. The results showed an EMGMF decrease across the repetitions accompanied by a progressive increase of the EMGRMS across the repetitions for all protocols and muscles. The EMGRMS was higher in protocol C when compared with protocol A and B for pectoralis major. The EMGMF was lower in protocols B and C than in protocol A for pectoralis major throughout the sets and repetitions. A higher EMGRMS and a lower EMGMF were observed in protocols B and C compared with protocol A for triceps brachii, solely in the fifth repetition. In conclusion, training protocols conducted with the same repetition duration, but with different concentric and eccentric durations, produce distinct muscle activation and neuromuscular fatigue responses, in which performing longer concentric durations could be the more appropriate strategy to increase muscle activation and neuromuscular fatigue.