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Objective To determine the effect of intrauterine cephapirin (0.5 g) treatment on the reproductive performance of cows diagnosed as at risk of developing endometritis. Methods Cows (n = 1325) from 17 seasonal calving dairy herds were enrolled if they had been calved for more than 6 days and had a condition that placed them at risk of endometritis. Half were treated with intrauterine cephapirin at an examination performed 28–37 days prior to mating start date (MSD). Cows were scored for body condition, their vaginal discharge was scored using vaginoscopy (VV), and the uterus and ovaries were assessed by rectal palpation. Results Overall, there was no significant treatment effect on reproductive performance. In 945 modified at risk (MAR) cows the effect of treatment varied with the calving to treatment interval (CTI) and VV status. For the subset of 229 MAR cows with CTI ≤ 28 days, treatment improved the proportions of first-service conception (OR 3.1; P < 0.01) and 6-week in-calf (OR 2.1; P < 0.05), and reduced the mean MSD to conception interval by 20 days (P < 0.05). The difference was greater in cows with a positive VV score (1–3). Treated VV-negative cows with CTI > 48 days had a reduced proportion of cows in-calf by 6 weeks (OR 0.58; P = 0.056) compared with untreated cows. Conclusion Intrauterine cephapirin infusion of MAR cows improved reproductive performance, depending on CTI. The greater treatment effect in VV-positive cows suggests that VV scoring is a useful tool for the diagnosis of endometritis. [ABSTRACT FROM AUTHOR]

OBJECTIVES: To determine whether changes in strength or cardiorespiratory fitness after exercise training improve walking ability in individuals who have had a stroke. DESIGN: A sham exercise-controlled, randomized two-by-two factorial design, in which the two factors investigated were cycle training (AEROBIC) and resistance training (STRENGTH). SETTING: University exercise laboratory. PARTICIPANTS: Fifty-two individuals with a history of stroke (aged 63+/-9; time since stroke, 57+/-54 months). INTERVENTION: Participants undertook 30 exercise sessions over 10 to 12 weeks. Depending on group allocation, individuals underwent aerobic cycling plus sham progressive resistance training (PRT) (n=13), sham cycling plus PRT (n=13), aerobic cycling plus PRT (n=14), or sham cycling plus sham PRT (n=12). MEASUREMENTS: Primary outcomes were 6-minute walk distance, habitual and fast gait velocities, and stair climbing power. Secondary outcomes included measures of cardiorespiratory fitness; muscle strength, power, and endurance; and psychosocial attributes. RESULTS: Neither AEROBIC nor STRENGTH improved walking distance or gait velocity significantly more than sham exercise, although STRENGTH significantly improved participants' stair climbing power by 17% (P=.009), as well as their muscle strength, power, and endurance; cycling peak power output; and self-efficacy. Conversely, AEROBIC improved indicators of cardiorespiratory fitness only. Cycling plus PRT produced larger effects than either single modality for mobility and impairment outcomes. CONCLUSION: Single-modality exercises targeted at existing impairments do not optimally address the functional deficits of walking but do ameliorate the underlying impairments. The underlying cardiovascular and musculoskeletal impairments are significantly modifiable years after stroke with targeted robust exercise. [ABSTRACT FROM AUTHOR]

Background: Functional electrical stimulation (FES) cycling has been reported to enhance muscle strength and improve muscle fatigue resistance after spinal cord injury (SCI). Despite its proposed benefits, the quantification of muscle fatigue during FES cycling remains poorly documented. This study sought to quantify the relationship between the vibrational performance of electrically-evoked muscles measured through mechanomyography (MMG) and its oxidative metabolism through near-infrared spectroscopy (NIRS) characteristics during FES cycling in fatiguing paralyzed muscles in individuals with SCI., Methods: Six individuals with SCI participated in the study. They performed 30 min of FES cycling with MMG and NIRS sensors on their quadriceps throughout the cycling, and the signals were analyzed., Results: A moderate negative correlation was found between MMG root mean square (RMS) and oxyhaemoglobin (O 2 Hb) [r = -0.38, p = 0.003], and between MMG RMS and total hemoglobin (tHb) saturation [r = -0.31, p = 0.017]. Statistically significant differences in MMG RMS, O 2 Hb, and tHb saturation occurred during pre- and post-fatigue of FES cycling (p < 0.05)., Conclusions: MMG RMS was negatively associated with O 2 Hb and muscle oxygen derived from NIRS. MMG and NIRS sensors showed good inter-correlations, suggesting a promising use of MMG for characterizing metabolic fatigue at the muscle oxygenation level during FES cycling in individuals with SCI., (© 2024 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

Background: Repetitive electrically-evoked muscle contractions lead to the early onset of muscle fatigue. This study assessed the relationship between muscle mechanomyography (%RMS-MMG) and tissue oxygen saturation (%TSI) in extensor carpi radialis (ECR) during electrically-evoked fatiguing exercise in individuals with tetraplegia., Methods: Skin-surface mechanomyography (MMG) and near-infrared spectroscopy (NIRS) sensors were placed on the ECR of seven individuals with tetraplegia. All participants performed repetitive electrically-evoked wrist extension to fatigue while their muscle MMG and NIRS responses were monitored against their power output (PO)., Findings: One out of seven participants showed no changes in %TSI throughout the repeated wrist FES-evoked contraction. The other six participants' %TSI was positively correlated with %PO before fatigue onset. At 50%PO peak , %TSI was negatively correlated (0.489) significantly with declining %PO as the ability of the muscle to take up oxygen became limited. The %RMS-MMG behaved analogously during pre and post-fatigue against declining %PO, whereby both displayed positive correlations of 0.443 and 0.214, respectively, (%RMS-MMG decreased) throughout the exercise session. Regression analysis revealed that %TSI was proportional to pre-fatigue and inversely proportional to %RMS-MMG during post-fatigue., Conclusion: The significant changes in muscle mechanomyography and tissue oxygenation correlations after 50%PO peak implied that the muscle contraction mechanical-and-physiological behavior association had been altered following FES-evoked fatigue., (© 2022 International Center for Artificial Organ and Transplantation (ICAOT) and Wiley Periodicals LLC.)

Aims: Limited data exist about the use of insulin degludec in the hospital. This multicentre, non-inferiority, open-label, prospective randomized trial compared the safety and efficacy of insulin degludec-U100 and glargine-U100 for the management of hospitalized patients with type 2 diabetes., Methods: In total, 180 general medical and surgical patients with an admission blood glucose (BG) between 7.8 and 22.2 mmol/L, treated with oral agents or insulin before hospitalization were randomly allocated (1:1) to a basal-bolus regimen using degludec (n = 92) or glargine (n = 88), as basal and aspart before meals. Insulin dose was adjusted daily to a target BG between 3.9 and 10.0 mmol/L. The primary endpoint was the difference in mean hospital daily BG between groups., Results: Overall, the randomization BG was 12.2 ± 2.9 mmol/L and glycated haemoglobin 84 mmol/mol (9.8% ± 2.0%). There were no differences in mean daily BG (10.0 ± 2.1 vs. 10.0 ± 2.5 mmol/L, p = .9), proportion of BG in target range (54·5% ± 29% vs. 55·3% ± 28%, p = .85), basal insulin (29.6 ± 13 vs. 30.4 ± 18 units/day, p = .85), length of stay [median (IQR): 6.7 (4.7-10.5) vs. 7.5 (4.7-11.6) days, p = .61], hospital complications (23% vs. 23%, p = .95) between treatment groups. There were no differences in the proportion of patients with BG <3.9 mmol/L (17% vs. 19%, p = .75) or <3.0 mmol/L (3.7% vs. 1.3%, p = .62) between degludec and glargine., Conclusion: Hospital treatment with degludec-U100 or glargine-U100 is equally safe and effective for the management of hyperglycaemia in general medical and surgical patients with type 2 diabetes., (© 2021 John Wiley & Sons Ltd.)

Aim: To compare a glucagon-like peptide-1 receptor agonist with basal insulin at hospital discharge in patients with uncontrolled type 2 diabetes in a randomized clinical trial., Methods: A total of 273 patients with glycated haemoglobin (HbA1c) 7%-10% (53-86 mol/mol) were randomized to liraglutide (n = 136) or insulin glargine (n = 137) at hospital discharge. The primary endpoint was difference in HbA1c at 12 and 26 weeks. Secondary endpoints included hypoglycaemia, changes in body weight, and achievement of HbA1c <7% (53 mmol/mol) without hypoglycaemia or weight gain., Results: The between-group difference in HbA1c at 12 weeks and 26 weeks was -0.28% (95% CI -0.64, 0.09), and at 26 weeks it was -0.55%, (95% CI -1.01, -0.09) in favour of liraglutide. Liraglutide treatment resulted in a lower frequency of hypoglycaemia <3.9 mmol/L (13% vs 23%; P = 0.04), but there was no difference in the rate of clinically significant hypoglycaemia <3.0 mmol/L. Compared to insulin glargine, liraglutide treatment was associated with greater weight loss at 26 weeks (-4.7 ± 7.7 kg vs -0.6 ± 11.5 kg; P < 0.001), and the proportion of patients with HbA1c <7% (53 mmol/mol) without hypoglycaemia was 48% versus 33% (P = 0.05) at 12 weeks and 45% versus 33% (P = 0.14) at 26 weeks in liraglutide versus insulin glargine. The proportion of patients with HbA1c <7% (53 mmol/mol) without hypoglycaemia and no weight gain was higher with liraglutide at 12 (41% vs 24%, P = 0.005) and 26 weeks (39% vs 22%; P = 0.014). The incidence of gastrointestinal adverse events was higher with liraglutide than with insulin glargine (P < 0.001)., Conclusion: Compared to insulin glargine, treatment with liraglutide at hospital discharge resulted in better glycaemic control and greater weight loss, but increased gastrointestinal adverse events., (© 2021 John Wiley & Sons Ltd.)

Aim: To assess whether treatment with sitagliptin, starting before surgery and continued during the hospital stay, can prevent and reduce the severity of perioperative hyperglycaemia in patients with type 2 diabetes undergoing coronary artery bypass graft (CABG) surgery., Materials and Methods: We conducted a double-blinded, placebo-controlled trial in adults with type 2 diabetes randomly assigned to receive sitagliptin or matching placebo starting 1 day prior to surgery and continued during the hospital stay. The primary outcome was difference in the proportion of patients with postoperative hyperglycaemia (blood glucose [BG] > 10 mmol/L [>180 mg/dL]) in the intensive care unit (ICU). Secondary endpoints included differences in mean daily BG in the ICU and after transition to regular wards, hypoglycaemia, hospital complications, length of stay and need of insulin therapy., Results: We included 182 participants randomized to receive sitagliptin or placebo (91 per group, age 64 ± 9 years, HbA1c 7.6% ± 1.5% and diabetes duration 10 ± 9 years). There were no differences in the number of patients with postoperative BG greater than 10 mmol/L, mean daily BG in the ICU or after transition to regular wards, hypoglycaemia, hospital complications or length of stay. There were no differences in insulin requirements in the ICU; however, sitagliptin therapy was associated with lower mean daily insulin requirements (21.1 ± 18.4 vs. 32.5 ± 26.3 units, P = .007) after transition to a regular ward compared with placebo., Conclusion: The administration of sitagliptin prior to surgery and during the hospital stay did not prevent perioperative hyperglycaemia or complications after CABG. Sitagliptin therapy was associated with lower mean daily insulin requirements after transition to regular wards., (© 2020 John Wiley & Sons Ltd.)

Background We sought to characterize body composition abnormalities in young patients living with a Fontan circulation and explore potential pathophysiologic associations. Methods and Results Twenty-eight patients with a Fontan circulation were prospectively recruited in this cross-sectional study. Participants underwent cardiopulmonary exercise testing, dual-energy X-ray absorptiometry, echocardiography, and biochemical assessment. Mean age was 26±7 years. Skeletal muscle mass, estimated by appendicular lean mass index Z score, was reduced compared with reference data (-1.49±1.10, P <0.001). Percentage body fat Z score overall was within normal range (0.23±1.26, P =0.35), although 46% had elevated adiposity. Those with reduced skeletal muscle mass (appendicular lean mass index Z score of -1 or lower) had lower percent predicted oxygen pulse (55±15 versus 76±16%, P =0.002). Overall agreement between body mass index and dual-energy X-ray absorptiometry to assess adiposity was fair only (weighted [linear] κ coefficient: 0.53; 95% CI, 0.34-0.73) and slight in the setting of muscle mass deficiency (weighted κ coefficient: 0.32; 95% CI, 0.13-0.50). Appendicular lean mass was independently associated with absolute peak VO 2 (β=70.6 mL/min, P =0.001). Appendicular lean mass index Z score was inversely associated with hemoglobin ( r =-0.4, P =0.04), and the degree of muscle deficit was associated with ventricular systolic impairment. Conclusions Young patients with a Fontan circulation have a body composition characterized by reduced skeletal muscle mass, which is associated with peak exercise capacity. Increased adiposity is common despite a normal body mass index. Low skeletal muscle mass is associated with systolic dysfunction and compensatory erythrocytosis.

This is a case series study with the objective of comparing two motion sensor automated strategies to avert knee buckle during functional electrical stimulation (FES)-standing against a conventional hand-controlled (HC) FES approach. The research was conducted in a clinical exercise laboratory gymnasium at the University of Sydney, Australia. The automated strategies, Aut-A and Aut-B, applied fixed and variable changes of neurostimulation, respectively, in quadriceps amplitude to precisely control knee extension during standing. HC was an "on-demand" increase of stimulation amplitude to maintain stance. Finally, maximal FES amplitude (MA) was used as a control condition, whereby knee buckle was prevented by maximal isometric muscle recruitment. Four AIS-A paraplegics undertook 4 days of testing each, and each assessment day comprised three FES standing trials using the same strategy. Cardiorespiratory responses were recorded, and quadriceps muscle oxygenation was quantified using near-infrared spectroscopy. For all subjects, the longest standing times were observed during Aut-A, followed by Aut-B, and then HC and MA. The standing times of the automated strategies were superior to HC by 9-64%. Apart from a lower heart rates during standing (P = 0.034), the automation of knee extension did not promote different cardiorespiratory responses compared with HC. The standing times during MA were significantly shorter than during the automated or "on-demand" strategies (by 80-250%). In fact, the higher isometric-evoked quadriceps contraction during MA resulted in a greater oxygen demand (P < 0.0001) and wider arteriovenous oxygen extraction (P = 0.08) when compared with the other strategies. In conclusion, even though increased standing times were demonstrated using automated control of knee extension, physiological benefits compared with HC were not evident., (Copyright © 2015 International Center for Artificial Organs and Transplantation and Wiley Periodicals, Inc.)

Functional electrical stimulation (FES)-induced leg exercise offers the potential for individuals with lower-limb paralysis to otherwise gain some benefits conferred by leg exercise. Although its original intent is to reactivate the leg muscles to produce functional upright mobility, as a rehabilitation therapy, FES-evoked exercise increases the whole-body metabolism of individuals with spinal cord injury (SCI) so that they may gain general and localized health and fitness benefits. The physiological and psychosocial responses during FES-evoked cycling, standing, rowing, leg extension, or stepping have been extensively explored for over 20 years. Some of the advantages of such exercise include augmented cardiorespiratory fitness, promotion of leg blood circulation, increased activity of specific metabolic enzymes or hormones, greater muscle volume and fiber size, enhanced functional exercise capacity such as strength and endurance, and altered bone mineral density. Positive psychosocial adaptations have also been reported among SCI individuals who undergo FES exercise. This article presents a position review of the available literature on the effects of FES-evoked exercise since the earliest date until 2007, to warrant a conclusion about the current status and potential of FES-evoked exercise for paralyzed people.